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Intraoperative hypothermia in colectomy patients not associated with increased risk for SSI
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A sustained period of intraoperative hypothermia in patients who underwent segmental colectomy was not associated with an increased risk for developing a surgical site infection compared with patients in whom perioperative normothermia was maintained, according to recent study data.
“It is well known that severe hypothermia negatively impacts multiple physiologic processes, but the real focus on perioperative normothermia began in the late 1990s after hypothermia was linked to surgical site infections [SSIs],” Rebeccah B. Baucom, MD, division of general surgery, Vanderbilt University Medical Center, told Healio Gastroenterology. “There are costs associated with keeping patients normothermic, including disposable warming gowns, special infusers, etc., and the true impact of normothermia on SSI reduction is unclear. We aimed to determine whether failure to attain the current quality metric was associated with SSI, and to explore potentially more robust definitions of hypothermia.”
Rebeccah B. Baucom
Baucom and colleagues performed a retrospective cohort study involving 296 adults (mean age, 61.8 years; 51.7% male) with colorectal cancer, endoscopically unresectable colon polyp or diverticular disease, who underwent elective segmental colectomy at a single tertiary-referral center from January 2005 through December 2009. Patients with a postoperative stoma, an emergent or urgent procedure, or a diagnosis of inflammatory bowel disease were excluded from the study. The primary outcome was 30-day SSI.
Perioperative temperature was continuously measured, and the researchers explored temperature nadir, mean intraoperative temperature, percentage of time at the temperature nadir and percentage of time with a temperature less than 36°C as other potential definitions of hypothermia.
Overall, 92.9% of patients achieved the quality metric and had a final intraoperative temperature of at least 36°C, and SSI rate at 30 days was 12.2%. Baucom and colleagues found no significant differences in temperature between patients with SSI and those without SSI. Adjusting for BMI, smoking status and sex, logistic regression models showed no association between intraoperative hypothermia and 30-day SSI (OR = 1.17; 95% CI, 0.76-1.81). Increased BMI was associated with SSI in all four models (OR = 1.39; 95% CI, 1.1-1.76).
“The quality metric was attained for the majority of patients, and temperature nadir, mean intraoperative temperature, and percentage of time spent hypothermic were not associated with postoperative SSI,” Baucom said. “Normothermia certainly has physiologic benefits, but further reduction in the rate of SSI after colectomy will require us to direct our attention away from hypothermia toward other modifiable risk factors.” – by Adam Leitenberger
Disclosure: Baucom reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
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