Early Postoperative Fever in Pediatric Oncology Patients Undergoing Solid Tumor Resection
Expert / Speaker
John Lundstedt, Emily Vore, Joseph Brungardt, Meera Kotagal, Todd Jenkins, Chloe Boehmer, Roshni Dasgupta
Oncology
Timestops
0:00
Introduction to Post-Operative Fever
The speaker introduces the topic of post-operative fever in pediatric oncology patients, specifically after hepatoblastoma resection, and presents findings from a study regarding fever incidence and infection rates.
0:10
Study Findings on Fever Incidence
A study involving 220 oncology patients reveals that 42% experienced fever within 48 hours post-surgery, yet only a small percentage had actual infections.
0:20
Understanding Infection Rates
Discussion on the low infection rate among febrile patients post-tumor resection, emphasizing the importance of identifying hemodynamic instability and overt signs of infection.
0:30
Cost Implications of Fever Workups
Analysis of the financial burden associated with unnecessary fever workups, averaging $500 per patient, and the implications for healthcare resources.
0:41
Guidelines for Fever Management
Recommendations for managing fever in post-operative patients, advocating for conservative approaches and reserving extensive workups for high-risk patients.
0:51
Conclusion and Key Takeaways
Summarization of the key points regarding fever management in pediatric oncology, highlighting the need for careful assessment before initiating extensive workups.
Topic overview
John Lundstedt, Emily Vore, Joseph Brungardt, Meera Kotagal, Todd Jenkins, Chloe Boehmer, Roshni Dasgupta
Postoperative fever is common following cancer resection and often prompts extensive, costly workups. The purpose of this study was to determine the incidence of and risk factors for postoperative fever in oncology patients, evaluate incidence of true infection, and determine the utility of fever workup.
Methods
Single institution retrospective chart review (2018–2023) identified postoperative oncology patients who developed postoperative fever (≥38.0 °C) on postoperative days 0, 1, or 2 following solid tumor resection. Collected variables included preoperative chemotherapy, presence of central line, operation type, bowel resection, operative length, wound class, intraoperative hypothermia (<35 °C), transfusion, hyperglycemia (>180 mg/dL), preoperative neutrophil count, and antibiotic administration. Fever workup included urinalysis, urine culture, blood culture, and chest x-ray. Fever predictors were analyzed using a generalized linear mixed model.
Results
Cohort included 222 patients, aged 0.01–40.35 years (median 5.27, SD = 8.32). Ninety-four patients (42 %) developed early postoperative fever. Factors predictive of developing fever included intraoperative transfusion (p = 0.032), postoperative transfusion (p = 0.032), foley catheter (p < 0.001), neutropenia (p = 0.001), and sarcoma histology (p = 0.006). Of those who developed fever, 36 % (34/94) were treated with empiric antibiotics and 73.4 % (69/94) underwent febrile workup (average cost $455). Only 2.8 % (2/94) of febrile patients had an infectious etiology requiring treatment. Both had hemodynamic instability and positive blood cultures.
Conclusions
Postoperative fever is common in pediatric cancer patients. Infectious etiology is rare, empiric treatment is common, and workup is costly. Fever alone may not necessitate a workup within the first 2 postoperative days following solid tumor resection. Testing and treatment should be reserved for those with significant symptomatology.
Intended audience: Healthcare professionals and clinicians.
Categories
Disease/Condition
Anatomy/Organ System
Procedure/Intervention
Care Context
Keywords
hospitals
oncology
hepatoblastoma
tumor resection
post-operative care
fever management
infection
hemodynamic stability
blood cultures
empiric antibiotics
pediatric patients
cost-effectiveness
clinical guidelines
patient safety
monitoring
symptom assessment
medical decision-making
fever workup
post-surgical complications
Hashtags
#Hepatoblastoma
#Oncology
#Pediatrics
#PostOpCare
#FeverManagement
#InfectionControl
#ClinicalGuidelines
#PatientSafety
#CostEffectiveness
#EmpiricAntibiotics
#MedicalEducation
#SymptomAssessment
#TumorResection
#HealthcareCosts
#Monitoring
#SurgicalComplications
#HemodynamicStability
#PediatricOncology
#EvidenceBasedMedicine
Transcript
Speaker: John Lundstedt, Emily Vore, Joseph Brungardt, Meera Kotagal, Todd Jenkins, Chloe Boehmer, Roshni Dasgupta
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