THe significance of fever following operations in children.

To determine the incidence and clinical significance of early postoperative fever, all children (n = 256) undergoing surgery in the main operating theatres during a 4 wk period were studied. Admission and operating room data were reviewed and the clinical record was monitored at 12 hourly intervals for the first 3 postoperative days. The patients were followed for 1 mo for the development of recognizable complications. Seventy-three children (28.5%) developed fever greater than 38 degrees C but in only four (1.6%) did this represent a septic process. Physical examination led to the proper diagnosis in all. Risk factors that correlated statistically with postoperative fever were operation of greater than 2 hr (p less than .001), intraoperative transfusion (p less than .001), preexisting infection (p less than .01) and the use of preoperative antibiotics (p less than .001). Anatomic site of operation, age and sex were not significant factors. We conclude that many factors other than infection are responsible for post-operative fever. Further, only a very small proportion of children with early postoperative fever develop significant septic complications. In the assessment of postoperative fever a protocol which indiscriminately includes lab investigations and X-rays is costly and usually not diagnostic. Laboratory tests are indicated mainly to confirm diagnoses suspected by clinical evaluation.