Association of post-tonsillectomy fever with postoperative complications

Objective: To investigate the incidence and risk factors associated with postoperative fever following tonsillectomy or adenotonsillectomy in pediatric patients, and explore its potential correlation with subsequent hemorrhage, emergency room (ER) visits, and rehospitalizations. Study design: Retrospective cohort study. Setting: Pediatric patients undergoing total or partial tonsillectomy or adenotonsillectomy between 2015 and 2022 across six medical centers. Methods: Patients were divided based on recorded postoperative temperature (within 24 h) into study (temperature ≥ 38 °C) and control group (Temperature < 38 °C). Primary outcomes included hemorrhage complications within 14 days post-procedure, secondary outcomes included ER visits and rehospitalizations. Results: This study included 2,512 pediatric patients; 426 in the study group and 2,086 in the control group. The study group exhibited significantly higher proportions of post-operative hemorrhages (6.8% vs. 3.4%, p < 0.001), increased ER visits (18% vs 9.6%, p < 0.001), elevated readmission rates (12% vs 5.7%, p < 0.001), and longer postoperative hospital stay (median 2.00 day [IQR 1.00, 2.00] vs 1.00 day [IQR 0.00, 1.00], p < 0.001) compared to the control group. Multivariate analyses controlled for age, sex, and operation type showed post-operative fever correlated significantly with hemorrhage, readmissions, and ER visits (OR 3.23, p < 0.001, OR 2.93, p < 0.001, OR 2.36, p < 0.001 respectively). Conclusions: Postoperative fever independently correlates with an increased risk of hemorrhage and readmission following tonsillectomy or adenotonsillectomy. These findings suggest that fever may serve as an early marker for complications, reinforcing its clinical importance in guiding postoperative care strategies and caregiver education. Level of evidence: 3.