MSOA 2018

Early Postoperative Fever in Pediatric Patients undergoing Cochlear Implant Surgery

Chilaf Peled 1,2 Sabri El-Saied 1,2 Ben-Zion Joshua 1,2 Muhammad Abu Tailakh 3 Mordechai Kraus 1,2 Daniel Kaplan 1,2
1Department of Otolaryngology-Head & Neck Surgery, Soroka University Medical Center
2Faculty of Health Sciences, Ben-Gurion University of the Negev
3Clinical Research Center, Faculty of Health Sciences, Ben-Gurion University of the Negev

Objectives: To determine the incidence, course, and outcome of early postoperative fever (EPF) in children undergoing cochlear implant (CI) surgery. A secondary objective was to examine where the protocol of prophylactic antibiotic affected fever and complications.

Design: Retrospective chart review.

Setting: Tertiary care university hospital.

Participants: All cochlear implant surgery procedures in children between 2004 and 2012.

Main outcome measures: Presence of EPF, type of surgery (unilateral, bilateral, or revision), early and late local complications, length of hospitalization, peri- and post-operative antibiotic treatment, and results of the fever workup.

Results: One hundred thirty patients aged 9 months to 6 years (mean 3.4±3.3 years) underwent CI surgery. All patients received intraoperative intravenous amoxicillin-clavulanic acid (25 mg/kg ×3). In the first 40 procedures (until 2008) the same antibiotic was continued orally for one week after 2008 antibiotics were stopped after 24 hour. Fever developed postoperatively in at least one measurement after 25 procedures (19%); 18 of them have a documented investigation of fever, four patients had blood cultures taken, and one patient with persistent fever reaching 40°C, had a lumbar puncture. Physical exams in all patients were normal. The presence of fever was not related to the patients` or the procedure`s characteristics. Fever lengthened the median hospitalization from 2.0 to 2.6 days.

There was no correlation between post-operative local complication and the presence of early postoperative fever.

Conclusion: Early postoperative fever in children undergoing CI surgery is not unusual and the phenomenon seems to be benign. Extensive evaluation including blood and urine cultures as well as chest imaging has little to no benefit in patients admitted for elective CI surgery. Additionally 24 hour amoxicillin-clavulanic acid seems sufficient prophylaxis for this procedure.

Chilaf Peled
Chilaf Peled
Soroka Medical Center








Powered by Eventact EMS