A retrospective review was undertaken of 126 consecutive craniofacial
procedures involving a transcranial component, performed at the Childr
en's Medical Center at Dallas, between 1990 and 1994. Standard postope
rative axillary temperature measurements were recorded until discharge
. Age at surgery of less than 24 months correlated very strongly with
a postoperative temperature of greater than 38 degrees C (r = -0.92).
The incidence of postoperative fever was high in all age groups, yet t
here was still a significant difference between the group younger than
2 years and the group in which surgery was performed after the age of
2 years across all postoperative temperature ranges, from > 38 degree
s C to > 39.5 degrees C (p < 0.001, chi-square test). The white blood
cell count was elevated above the age-related normal in 67 percent of
febrile patients. There was no correlation between type or duration of
surgical procedure, length of intensive care or hospital stay, or the
need for blood transfusion and the development of a significant posto
perative fever. There were minor infectious complications in four pati
ents (3 percent), only one of which was a wound problem related to the
surgery. All infectious complications were easily identifiable clinic
ally. There was no mortality or serious infections. The development of
postoperative fever, and an elevated white blood cell count, is to be
expected in pediatric patients undergoing craniofacial procedures. Th
e routine laboratory investigation of postoperative fever in pediatric
craniofacial patients under 2 years of age without procedures involvi
ng transgression of the paranasal sinuses is not warranted unless ther
e are associated clinical indicators.