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Pediatric Otolaryngology

Immediate Postoperative Fever in Children With PFAPA Syndrome Undergoing Tonsillectomy

Monday, October 2, 2023
5:48 PM - 5:54 PM East Coast USA Time
Location: 207CD

    Presenting Author(s)

  • Ory Madgar, MD

    Resident
    Department of Otolaryngology, Head and Neck Surgery, the Sheba Medical Center, Tel-Hashomer, Israel
    Ramat Gan, Israel

    • Senior Author(s)

  • Ory Madgar, MD

    Resident
    Department of Otolaryngology, Head and Neck Surgery, the Sheba Medical Center, Tel-Hashomer, Israel
    Ramat Gan, Israel

    • Co-Author(s)

  • Amber D. Shaffer, PhD

    Research Manager
    Children's Hospital of Pittsburgh
    Pittsburgh, PA, United States

  • David H. Chi, MD

    Division Chief
    University of Pittsburgh Medical Center, Children's Hospital of Pittsburgh
    Pittsburgh, PA, United States

Introduction: Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is the most common periodic fever syndrome in children. Tonsillectomy is considered a potential treatment option for this syndrome.
A common concern is that patients with PFAPA might be more likely to have post-op fever, which might be hard to distinguish from other etiologies such as malignant hyperthermia or adverse drug effect. For this reason, many institutes require these patients to be cared for at their main center and not at satellite centers.
Our objective was to evaluate the prevalence of immediate post-op fever in PFAPA patients undergoing tonsillectomy.

Methods: The Pediatric Health Information System (PHIS) database was queried from January 1st, 2013 to June 30th, 2022. Patients ages 1-18 years at admission and a principal procedure of tonsillectomy (ICD-9: 28.2,28.3; ICD-10: 0CTPXZZ; 0CTP0ZZ; 0C5P0ZZ; 0C5PXZZ; 0CBP0ZZ; 0CBP3ZZ; 0CBPXZZ) were included. Flags were created for PFAPA (ICD-9: 780.61; ICD-10 M04.8) and post-procedural fever (ICD-9: 780.62; ICD-10: R50.82). Query also included gender, age at admission, length of stay (LOS), and admission year.

Results: 481,118 pediatric tonsillectomies were recorded in the PHIS database during this period. 1197 (0.25%) were also diagnosed with PFAPA. Patients with PFAPA were younger at tonsillectomy (median 4.68 years, range 3.19-6.61 years) compared with those without PFAPA (median 5.85 years, range 3.85-8.71 years, p< 0.001). Tonsillectomies were more commonly performed as ambulatory surgeries, rather than observation or inpatient, in children with PFAPA (χ=11.7, p=0.003). None of the patients with PFAPA had immediate post-op fever. However, patients with PFAPA were significantly more likely to have a LOS of >1 Day (OR: 1.30, 95% CI: 1.01-1.66, p=0.043). There has been a fluctuation in the percentage of tonsillectomy cases comprised of PFAPA patients, with PFAPA becoming more common in recent years (OR: 1.20, 95% CI: 1.17-1.22, p< 0.001)

Conclusions: Our results suggest no increased risk of immediate post-op fever in PFAPA patients undergoing tonsillectomy.