Association Between Perioperative Hypothermia and Surgical Site Infection After Elective Abdominal Surgery: A Prospective Cohort Study

Abstract

Introduction Surgical site infections (SSIs) account for 14-16% of nosocomial infections and are one of the major causes of increased morbidity, hospital stay, cost of care, and even mortality. Hypothermia as a risk factor for SSI is debated but there is lack of conclusive evidence. The present study explores the association of hypothermia with SSI. Methodology This is a prospective cohort study conducted on adult patients who underwent elective laparotomy. Patients were divided into two cohorts, the Hypothermia Cohort and the Normothermia Cohort, based upon episodes of hypothermia of <36 0 C in the perioperative period. SSI was diagnosed based upon criteria defined by the Center for Disease Control and Prevention (CDC). Postoperative follow-up to detect SSI was done until 30 days after the operation. Results A total of 183 patients met the selection criteria and were included in the study. Ninety patients (49%) had perioperative hypothermia and were followed in the Hypothermia Cohort, while 93 patients (51%) who remained normothermic in the perioperative period were followed in the Normothermia Cohort. Mean age of the patients was 49.77 +/-14.82 years. Almost two-thirds of the participants were females (63.9%). Patients who developed hypothermia were significantly older and had lower BMI. Also the proportion of female patients was significantly higher in the Normothermic Cohort. Rate of SSI was similar in both groups (10% versus 10.8%) with p-value of 0.867. Multivariable regression analysis also failed to show any significant association between hypothermia and SSI. Conclusion Our study failed to show any statistically significant association between hypothermia and surgical site infection.

Incidence of Severe Hypothermia and Its Impact on Postoperative Surgical Complications and Time Delay to Adjunct Treatments in Breast Surgery Cancer Patients: A Case-Controlled Study

“…Advanced age and an ASA class greater than 1 are known to significantly increase the occurrence of intraoperative hypothermia [17], but very few of our patients had those characteristics. No difference was noted in the remaining intraoperative parameters, although an increased risk of perioperative hypothermia has been associated with the duration of anesthesia and with surgery longer than 90 min in several studies [15,18].…”

Normothermia to Decrease Surgical Site Infection Risk: Silver Bullet or Fool's Gold? A Retrospective Cohort Study

“…Some evidence points to normothermia as a critical component in limiting SSIs, 9 , 13 , 15 whereas others suggest that it has little-to-no effect on the development of SSI. 17 , 31 Despite these conflicting findings and the potential effect on patient outcomes, there remains a paucity of literature addressing the importance of PH in the prevention of SSI.…”

“…Perioperative hypothermia was defined as a core temperature of 35.5°C or lower recorded during any part of the procedure. Despite previous studies defining hypothermia as CBT ≤36°C, 31 - 33 we chose to use a more stringent cutoff of 35.5°C to prevent patients with low basal body temperatures from being included in the hypothermic cohort. This decision mirrored that of Simpson et al 10 in their recent work.…”

Effects of Different Forced-air Warming systems on the Core Temperature of Patients: A Manikin and Multi-center Clinical Study

“…A series of clinically related in uencing factors may lead to this phenomenon, such as skin exposure in the operating area, patient age, anesthesia or operation type, cold ushing uid, low ambient temperature in the operating room, no heating of intravenous infusion, impaired thermoregulation control, etc [3][4][5]. Perioperative hypothermia increases the risk of surgical incision infection, coagulation dysfunction, increased intraoperative blood loss and postoperative chills, hypothermia also prolongs anesthesia recovery time, delays wound healing, increases hospitalization time, increases medical economic burden and reduces patient satisfaction [4,[6][7][8][9][10]. So as a result of these studies and others like them, preventing hypothermia should become a standard of nursing care for most surgical procedures.…”