Postoperative hypothermia and surgical site infection following peritoneal insufflation with warm, humidified carbon dioxide during laparoscopic colorectal surgery: a cohort study with cost-effectiveness analysis

Abstract

BackgroundSurgical Site Infection (SSI) occurs in 9 % of laparoscopic colorectal surgery. Warming and humidifying carbon dioxide (CO2) used for peritoneal insufflation may protect against SSI by avoiding postoperative hypothermia (itself a risk factor for SSI). This study aimed to assess the impact of CO2 conditioning on postoperative hypothermia and SSI and to perform a cost-effectiveness analysis.MethodsA retrospective cohort study of patients undergoing elective laparoscopic colorectal resection was performed at a single UK specialist centre. The control group (n = 123) received peritoneal insufflation with room temperature, dry CO2, whereas the intervention group (n = 123) received warm, humidified CO2 (using HumiGard™, Fisher & Paykel Healthcare). The outcomes were postoperative hypothermia, SSI and costs. Multivariate analysis was performed.ResultsA total of 246 patients were included in the study. The mean age was 68 (20–87) and mean BMI 28 (15–51). The primary diagnosis was cancer (n = 173), and there were no baseline differences between the groups. CO2 conditioning significantly decreased the incidence of postoperative hypothermia (odds ratio 0.10, 95 % CI 0.04–0.23), with hypothermic patients found to be at increased risk of SSI (odds ratio 4.0, 95 % CI 1.25–12.9). Use of conditioned CO2 significantly decreased the incidence of SSI by 66 % (p = 0.04). The intervention group incurred costs of £155 less per patient. The incremental cost-effectiveness ratio was negative.Conclusion CO2 conditioning during laparoscopic colorectal surgery is a safe, feasible and a cost-effective intervention. It improves the quality of surgical care relating to SSI and postoperative hypothermia.

Inadvertent Perioperative Hypothermia Risks and Postoperative Complications: A Retrospective Study

“…Perioperative hypothermia commonly is defined as a body temperature less than or equal to 36.0° C (≤96.8° F) during the perioperative continuum of care . Multiple studies describe negative outcomes associated with inadvertent hypothermia, including surgical site infection, coagulation dysfunction, increased intraoperative blood loss, sepsis, and mortality . Although the seriousness of postoperative complications varies, one research group found that mortality increased fourfold in patients who had experienced perioperative hypothermia .…”

Effects of a multifaceted individualized pneumoperitoneum strategy in elderly patients undergoing laparoscopic colorectal surgery

“…Other previous studies have reported that warming and humidifying CO 2 significantly decreases the risk of SSIs, and reduces readmission rates and length of hospital stay. [13,34] This differences may be due to the different types of surgery and insulation measures. Hypothermia results in subcutaneous vasoconstriction, and decreased oxygen tension in this layer at a wound site increases the risk of SSIs.…”

“…Earlier data suggest that cold, dry gas can cause structural and biochemical injury to the peritoneal mesothelium, which results in a local inflammatory and cytokine response that may increase postoperative pain, and potentially contribute to adhesion formation, tumor seeding, and systemic progression. [12,13] However, more recent evidence from high quality, randomized controlled trials and a Cochrane meta-analysis have shown no difference in postoperative pain scores or opiate use with warming and humidification. [14,15] Surgical site infections (SSIs) represent up to 20% of all healthcare-associated infections.…”

Einfluss einer lokalen Insufflation von befeuchtetem und erwärmtem CO2 auf die Wundoberflächen- und Körperkerntemperatur sowie auf die Wundheilung in der offenen Kolorektalchirurgie

“…Wundinfektionen traten signifikant häufiger in der Kontrollgruppe ohne Erwärmung auf (p = 0,001) [12]). Eine Kohortenstudie mit Kosten-Effektivitäts-Analyse zeigte eine signifikante Reduktion der Inzidenz von Wundheilungsstörungen nach laparoskopischen kolorektalen Resektionen mit Insufflation von befeuchtetem und erwärmtem Kohlendioxid [25].…”