• Nicholas C Field, Nataly Raviv, and Matthew A Adamo.
• Department of Neurosurgery, Albany Medical College, Albany, New York, USA. Electronic address: fieldn@amc.edu.
• World Neurosurg. 2019 Dec 1; 132: e430-e433.

BackgroundCraniosynostosis is the premature fusion of ≥1 cranial sutures. Surgical management involves early cranial vault reconstruction. Postoperative management of these patients is often complicated by fever of unknown origin and results in additional laboratory studies, extended hospital intensive care unit stays, and increased cost to the patient.MethodsA retrospective analysis of 70 consecutive patients who underwent cranial vault reconstruction were included. Postoperative fever (Tmax), length of stay, transfusions, estimated blood loss, and white blood cell counts were obtained, as well as blood, urine, and other culture data.ResultsMean age at surgery was 1.1 years. Sixty (86%) patients had idiopathic postoperative fevers >38°C. Of those, 20% underwent fever workups, none of which returned a positive culture or concern for pneumonia. Length of stay was significantly increased in patients who had fever workups (6.1 days vs. 4.7, P < 0.001). There was no significant difference in age, estimated blood loss, Tmax, white blood cell count, and day of postoperative fever between groups. The average estimated cost of a fever workup at our institution is $1288 (U.S. dollars).ConclusionsFever of unknown origin is a common finding after craniosynostosis repair. Workup for fever of unknown did not result in the identification of an infection and added significantly to the cost and patient's length of stay.Copyright © 2019 Elsevier Inc. All rights reserved.

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