Effect of perioperative hypothermia on surgical site infection in abdominal surgery: A prospective cohort study

Ribeiro, Julio Cesar; Bellusse, Gislaine Cristhina; Freitas, Isabel Cristina Martins de; Galvão, Cristina María

doi:10.1111/ijn.12934

Cited by 7 publications

(7 citation statements)

References 25 publications

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“…Maintenance of intra-operative normothermia has been associated with improved outcomes. There is strong evidence to suggest that hypothermia during surgery increases the risk of wound infections, cardiac complications, and blood loss 18 19. In our study we noticed no significant difference in the adherence to intra-operative normothermia between P1 and P3 (Table 2).…”

Section: Discussionmentioning

confidence: 39%

Patient outcomes and adherence to an enhanced recovery pathway for open gynecologic surgery: a 6-year single-center experience

Hayek

Zorrilla‐Vaca

Mena

et al. 2022

Int J Gynecol Cancer

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ObjectivesTo evaluate compliance with an Enhanced Recovery After Surgery (ERAS) protocol for open gynecologic surgery at a tertiary center and the relationship between levels of compliance and peri-operative outcomes.MethodsThis retrospective cohort study was conducted between November 2014 and December 2020. Two groups were defined based on compliance level (<80% vs ≥80%). The primary outcome was to analyze overall compliance since implementation of the ERAS protocol. The secondary endpoint was to assess the relationship between compliance and 30-day re-admission, length of stay, re-operation, opioid-free rates, and post-operative complications. We also assessed compliance with each ERAS element over three time periods (P1: 2014–2016, P2: 2017–2018, P3: 2019–2020), categorizing patients according to the date of surgery. Values were compared between P1 and P3.ResultsA total of 1879 patients were included. Overall compliance over the period of 6 years was 74% (95% CI 71.9% to 78.2%). Mean overall compliance increased from 69.7% to 75.8% between P1 and P3. Compliance with ERAS ≥80% was associated with lower Clavien–Dindo complication rates (grades III (OR 0.55; 95% CI 0.33 to 0.93) and V (OR 0.08, 95% CI 0.01 to 0.60)), 30-day re-admission rates (OR 0.61; 95% CI 0.43 to 0.88), and length of stay (OR 0.59; 95% CI 0.47 to 0.75). No difference in opioid consumption was seen. Pre-operatively, there was increased adherence to counseling by 50% (p=0.01), optimization by 21% (p=0.02), and carbohydrate loading by 74% (p=0.02). Intra-operatively, compliance with use of short-acting anesthetics increased by 37% (p=0.01) and avoidance of abdominal drainage increased by 7% (p=0.04). Use of goal-directed fluid therapy decreased by 16% (p=0.04). Post-operatively, there was increased compliance with avoiding salt and water overload (8%, p=0.02) and multimodal analgesia (5%, p=0.02).ConclusionsOver the time period of the study, overall compliance increased from 69.7% to 75.8%. Compliance (≥80%) with ERAS is associated with lower complication rates, fewer 30-day re-admissions, and shorter length of stay without impacting re-operation rates and post-operative opioid use.

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Section: Discussionmentioning

confidence: 39%

Patient outcomes and adherence to an enhanced recovery pathway for open gynecologic surgery: a 6-year single-center experience

Hayek

Zorrilla‐Vaca

Mena

et al. 2022

Int J Gynecol Cancer

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“…Intraoperative hypothermia negatively affects several outcomes, including an increase in wound infections, cardiopulmonary complications, and bleeding. 26 In addition, intraoperative hypothermia has been linked to delayed hospital discharge. 27 In this study, we could not establish a statistical correlation between hypothermia and wound complications, such as wound dehiscence or wound infection.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Simultaneous LAP Flaps in Breast Reconstruction: Perioperative anesthetic outcomes addressing safety and feasibility

Haddock

Ercan

Teotia

2023

Plastic &Amp; Reconstructive Surgery

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he deep inferior epigastric artery perforator (DIEP) flap remains the most common flap for autologous breast reconstruction, but it is not always the ideal option. In those instances, there are other secondary options, such as profunda artery perforator, 1,2 lateral thigh perforator, 3 or gluteal artery perforator (superior and inferior) flaps. 4 Recently, the lumbar artery perforator (LAP) flap has emerged as an excellent alternative option for breast reconstruction. 5 Even in patients with low body mass index (BMI), where there is a paucity of tissue and skin laxity in most anatomic regions, the lumbar area and LAP flap can often provide adequate volume and structure for total autologous tissue breast reconstruction. 6 Despite the multiple advantages of the LAP flap, there are concerns that prevent its common adoption. 7 First, the LAP flap is technically Background: The lumbar artery perforator (LAP) flap has emerged as an excellent option for breast reconstruction, but its steep learning curve makes it less approachable. Furthermore, length of the operation, flap ischemia time, need for composite vascular grafts, complex microsurgery, multiple position changes, and general concern for safety has led experienced surgeons to stage bilateral reconstructions. In the authors' experience, simultaneous bilateral LAP flaps are feasible, but overall perioperative safety has not been fully explored. Methods: Thirty-one patients (62 flaps) underwent simultaneous bilateral LAP flaps and were included in the study (excluding stacked four-flaps and unilateral flaps). Patients underwent two position changes in the operating room: supine to prone and then supine again. A retrospective review of patient demographics, intraoperative details, and complications was performed. Results:The overall flap success rate was 96.8%. Five flaps were compromised postoperatively. The intraoperative anastomotic revision rate was 24.1% per flap (4.3% per anastomosis). The significant complication rate was 22.6%. The number of sustained hypothermic episodes and hypotensive episodes correlated with intraoperative arterial thrombosis (P < 0.05). The number of hypotensive episodes and increased intraoperative fluid correlated with flap compromise (P < 0.05). High body mass index correlated with overall complications (P < 0.05). The presence of diabetes correlated with intraoperative arterial thrombosis (P < 0.05). Conclusions: Simultaneous bilateral LAP flaps can be performed safely with an experienced and trained microsurgical team. Hypothermia and hypotension negatively affect the initial anastomotic success. In this complex operation, a coordinated approach between the anesthesia and nursing team is paramount for patient safety.

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“…This leads to a reduction in metabolic heat production by approximately 20%. The combination of these factors can contribute to perioperative hypothermia [3,29].…”

Section: Physiological Effects Of Anesthesia and Hypothermiamentioning

confidence: 99%

Hypothermia Effects Observed Under Anesthesia: An Integrative Literature Review

Salgado,

Barros,

Auzier

et al. 2023

JAMMR

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Of the regular temperature of approximately 37°C, about 0.8°C are dedicated to the internal maintenance of the brain, heart and organs located in the abdomen, being said of the central temperature, with the aim of avoiding large variations in temperature, in order to favour the functions of the vital systems. When the central temperature drops to less than 36°C, then hypothermia occurs.The studies suggest the control and monitoring of the patient's temperature during surgery, and point out strategies for the maintenance of the temperature and loss of heat in the patient, from preheating with varying duration thermal blanket and heating of intravenous fluids.Thinking about this, the objective of this review was to provide comprehensive information about the effects of perioperative hypothermia and its risks and consequences in patients undergoing the anesthetic act within and outside the surgical block, from the study of the current available literature.The research led to ten publications, mostly listed with level I evidence (5); in other level II articles (2); only one level III article and fourth level articles. All the papers explored the control, monitoring, consequences and risks of perioperative hypothermia. Concluding that continuing education, training, building skills to implement the current hypothermia management guidelines and institutional support are fundamental aspects inining episodes of perioperative hypothermie.

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Effect of perioperative hypothermia on surgical site infection in abdominal surgery: A prospective cohort study

Cited by 7 publications

References 25 publications

Patient outcomes and adherence to an enhanced recovery pathway for open gynecologic surgery: a 6-year single-center experience

Patient outcomes and adherence to an enhanced recovery pathway for open gynecologic surgery: a 6-year single-center experience

Bilateral Simultaneous LAP Flaps in Breast Reconstruction: Perioperative anesthetic outcomes addressing safety and feasibility

Hypothermia Effects Observed Under Anesthesia: An Integrative Literature Review

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