A retrospective analysis on the relationship between intraoperative hypothermia and postoperative ileus after laparoscopic colorectal surgery

Abstract

Postoperative ileus (POI) is an important factor prolonging the length of hospital stay following colorectal surgery. We retrospectively explored whether there is a clinically relevant association between intraoperative hypothermia and POI in patients who underwent laparoscopic colorectal surgery for malignancy within the setting of an enhanced recovery after surgery (ERAS) program between April 2016 and January 2017 at our institution. In total, 637 patients were analyzed, of whom 122 (19.2%) developed clinically and radiologically diagnosed POI. Overall, 530 (83.2%) patients experienced intraoperative hypothermia. Although the mean lowest core temperature was lower in patients with POI than those without POI (35.3 ± 0.5°C vs. 35.5 ± 0.5°C, P = 0.004), the independence of intraoperative hypothermia was not confirmed based on multivariate logistic regression analysis. In addition to three variables (high age-adjusted Charlson comorbidity index score, long duration of surgery, high maximum pain score during the first 3 days postoperatively), cumulative dose of rescue opioids used during the first 3 days postoperatively was identified as an independent risk factor of POI (odds ratio = 1.027 for each 1-morphine equivalent [mg] increase, 95% confidence interval = 1.014–1.040, P <0.001). Patients with hypothermia showed significant delays in both progression to a soft diet and discharge from hospital. In conclusion, intraoperative hypothermia was not independently associated with POI within an ERAS pathway, in which items other than thermal measures might offset its negative impact on POI. However, as it was associated with delayed discharge from the hospital, intraoperative maintenance of normothermia is still needed.

Effect of different carbon dioxide (CO2) insufflation for laparoscopic colorectal surgery in elderly patients

“…[39] Previous multivariate logistic regression analysis revealed that anesthesia time and volume of CO 2 were the only independent risk factors for perioperative hypothermia during laparoscopic colorectal surgery. [40] However, both these factors are similar in our trial. Considering the cost-effectiveness analysis of perioperative warming, current guidance highlights the need to carry out prophylactic measures to avoid unintentional perioperative hypothermia during laparoscopic colorectal surgery.…”

Short-Periods of Pre-Warming in Laparoscopic Surgery. A Non-Randomized Clinical Trial Evaluating Current Clinical Practice

“…However, pre-warming for 5–15 min was not efficiently enough to reach statistical significance, likely because core temperature in P 5–15 group was lower than in the P > 15 group. On the other hand, hypothermia is not an independent risk factor for postoperative ileus, but its appearance delays the onset of oral tolerance [ 41 ]. We found no influence of pre-warming on decreasing the rate of postoperative ileus, probably due to its low prevalence in laparoscopic urological surgery.…”

Effect of warm bladder irrigation fluid for benign prostatic hyperplasia patients on perioperative hypothermia, blood loss and shiver: A meta-analysis

“…Perioperative hypothermia is defined as perioperative core temperature being lower than 36.0°C [5] , [32] . The difference in body temperature is related to the temperature regulating function in different patients, the ambient temperature of the operating room, type of the operation, and the duration of the operation, especially the operation with longer time of bladder irrigation.…”