Intraoperative Hypothermia During Cytoreductive Surgery for Ovarian Cancer and Perioperative Morbidity

Moslemi-Kebria, Mehdi; El-Nashar, Sherif A.; Aletti, Giovanni; Cliby, William A.

doi:10.1097/aog.0b013e3182475f8a

Cited by 43 publications

(20 citation statements)

References 21 publications

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“…Notably, 50% of cases and 54.8% of controls experienced an end-operating body temperature of ≤36°C. While this factor was not different between cases and controls, the rate of hypothermia is substantial and may be a modifiable risk factor for overall surgical complications [44]. …”

Section: Resultsmentioning

confidence: 99%

Multiple large bowel resections: Potential risk factor for anastomotic leak

Kalogera¹,

Dowdy²,

Mariani³

et al. 2013

Gynecologic Oncology

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Objectives Identify risk factors of anastomotic leak (AL) after large bowel resection (LBR) for ovarian cancer (OC) and compare outcomes between AL and no AL. Methods All cases of AL after LBR for OC between 01/01/1994-05/20/2011 were identified and matched 1:2 with controls for age (+/−5years), sub-stage (IIIA/IIIB;IIIC;IV), and date of surgery (+/−4years). Patient-specific and intraoperative risk factors, use of protective stomas, and outcomes were abstracted. A stratified conditional logistic regression model was fit to determine the association between each factor and AL. Results 42 AL cases were evaluable and matched with 84 controls. Two-thirds of the AL had stage IIIC disease and >90% of both cases and controls were cytoreduced to <1cm residual disease. No patient-specific risk factors were associated with AL (pre-operative albumin was not available for most patients). Rectosigmoid resection coupled with additional LBR was associated with AL (OR=2.73, 95%CI 1.13–6.59, P=0.025), and protective stomas were associated with decreased risk of AL (0% vs. 10.7%, P=0.024). AL had longer length of stay (P<0.001), were less likely to start chemotherapy (P=0.020), and had longer time to chemotherapy (P=0.007). Cases tended to have higher 90-day mortality (P=0.061) and were more likely to have poorer overall survival (HR=2.05, 95%CI 1.18–3.57, P=0.011). Conclusions Multiple LBRs appear to be associated with increased risk of AL and protective stomas with decreased risk. Since AL after OC cytoreduction significantly delays chemotherapy and negatively impacts survival, surgeons should strongly consider temporary diversion in selected patients (poor nutritional status, multiple LBRs, previous pelvic radiation, very low anterior resection, steroid use).

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Section: Resultsmentioning

confidence: 99%

Multiple large bowel resections: Potential risk factor for anastomotic leak

Kalogera¹,

Dowdy²,

Mariani³

et al. 2013

Gynecologic Oncology

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“…Several meta‐analyses and RCTs have demonstrated that preventing inadvertent hypothermia during major abdominal surgery significantly reduces wound infections, cardiac complications, bleeding and transfusion requirements, and improves immune function, the duration of post‐anaesthetic recovery and overall survival . Therefore, it makes sense to prevent the loss of body heat as also recommended by the ERAS society.…”

Section: Part B Intraoperative and Postoperative Eras Elementsmentioning

confidence: 99%

Enhanced Recovery After Surgery (ERAS) for gastrointestinal surgery, part 2: consensus statement for anaesthesia practice

Feldheiser

Aziz

Baldini

et al. 2015

Acta Anaesthesiol Scand

540

418

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BackgroundThe present interdisciplinary consensus review proposes clinical considerations and recommendations for anaesthetic practice in patients undergoing gastrointestinal surgery with an Enhanced Recovery after Surgery (ERAS) programme.MethodsStudies were selected with particular attention being paid to meta‐analyses, randomized controlled trials and large prospective cohort studies. For each item of the perioperative treatment pathway, available English‐language literature was examined and reviewed. The group reached a consensus recommendation after critical appraisal of the literature.ResultsThis consensus statement demonstrates that anaesthesiologists control several preoperative, intraoperative and postoperative ERAS elements. Further research is needed to verify the strength of these recommendations.ConclusionsBased on the evidence available for each element of perioperative care pathways, the Enhanced Recovery After Surgery (ERAS ®) Society presents a comprehensive consensus review, clinical considerations and recommendations for anaesthesia care in patients undergoing gastrointestinal surgery within an ERAS programme. This unified protocol facilitates involvement of anaesthesiologists in the implementation of the ERAS programmes and allows for comparison between centres and it eventually might facilitate the design of multi‐institutional prospective and adequately powered randomized trials.

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“…Clinical studies in cancer patients have confirmed an association between perioperative factors such as hypothermia 37 , blood loss 38,39 , and postoperative infections 40,41 , and increased cancer recurrence and reduced cancer-specific survival following cancer surgery.…”

Section: Introductionmentioning

confidence: 97%