Risk factors for inadvertent intraoperative hypothermia in patients undergoing laparoscopic surgery: A prospective cohort study

Abstract

Background Inadvertent intraoperative hypothermia is frequent during open surgeries; however, few studies on hypothermia during laparoscopic abdominal surgery have been reported. We aimed to investigate the incidence and risk factors for hypothermia in patients undergoing laparoscopic abdominal surgery. Methods This single-center prospective cohort observational study involved patients undergoing laparoscopic surgery between October 2018 and June 2019. Data on core body temperature and potential variables were collected. A multivariate logistic regression analysis was performed to identify the risk factors associated with hypothermia. A Cox regression analysis was used to verify the sensitivity of the results. Results In total, 690 patients were included in the analysis, of whom 200 (29.0%, 95% CI: 26%−32%) had a core temperature < 36°C. The core temperature decreased over time, and the incident hypothermia increased gradually. In the multivariate logistic regression analysis, age (OR = 1.017, 95% CI: 1.000–1.034, P = 0.050), BMI (OR = 0.938, 95% CI: 0.880–1.000; P = 0.049), baseline body temperature (OR = 0.025, 95% CI: 0.010–0.060; P < 0.001), volume of irrigation fluids (OR = 1.001, 95% CI: 1.000–1.001, P = 0.001), volume of urine (OR = 1.001, 95% CI: 1.000–1.003, P = 0.070), and duration of surgery (OR = 1.010, 95% CI: 1.006–1.015, P < 0.001) were significantly associated with hypothermia. In the Cox analysis, variables in the final model were age, BMI, baseline body temperature, volume of irrigation fluids, blood loss, and duration of surgery. Conclusions Inadvertent intraoperative hypothermia is evident in patients undergoing laparoscopic surgeries. Age, BMI, baseline body temperature, volume of irrigation fluids, and duration of surgery are significantly associated with intraoperative hypothermia.

Risk Factors for Postoperative Hypothermia in Patients Undergoing Robot-Assisted Gynecological Surgery: A Retrospective Cohort Study

“…Additionally, the lower baseline body temperature identified as a risk factor in this study was consistent with that in other studies 2 , 8 , 11 , 15 , 19 . As baseline body temperature refers to the heat content of the periphery and temperature gradient of core-to-peripheral tissue, it is related to the magnitude of redistribution, which is an important cause of anesthesia-induced hypothermia 2 , 13 .…”

“…The incidence rate of postoperative hypothermia (28.1%) in this study is comparable to the incidence rate of intraoperative hypothermia (30.6%) in patients undergoing gynecological laparoscopic surgery 11 . However, it is lower than the incidence rate of intraoperative hypothermia in obstetric and gynecological surgeries, including open surgery (49.62%) 12 .…”

“…In the same context, although the amount of blood loss and transfusion are associated with hypothermia [26], in this study, the amount of blood loss could not be accurately assessed due to the nature of the retrospective study, and transfusion would not be identified as a risk factor because the number of patients who received blood transfusion was too small. Furthermore, age, sex, and duration of surgery, which are known risk factors for hypothermia after surgery [6,11,19], were not identified as risk factors in this study probably due to the following characteristics of robot-assisted gynecological surgery. Most patients in our study were middle-aged women, and the constant duration of surgery was observed in the present study due to the limited types of surgery in a single-center study.…”

“…Lower BMI is a well-known risk factor for perioperative hypothermia in patients receiving general anesthesia [13,14]. Although a higher BMI does not exactly mean a higher fat content, which serves as a buffer for maintaining body temperature during surgery, a lower BMI was confirmed as a risk factor for postoperative hypothermia in patients undergoing robot-assisted gynecological surgery, as in other surgeries, such as laparoscopic, video-assisted thoracoscopic, and orthopedic surgeries [6,11,15,16]. Obese patients experience early vasoconstriction when the core temperature decreases to maintain thermal balance due to a higher vasoconstriction threshold, showing less redistribution [17,18].…”

Comparison of Core Body Temperatures in Patients Administered Remimazolam or Propofol during Robotic-Assisted and Laparoscopic Radical Prostatectomy

“…Although the type and dose of intravenous anesthetics can affect thermoregulatory control, the remimazolam-based RR group, in terms of the incidence of intraoperative hypothermia, was not significant compared with propofol-base PR group in patients undergoing prolonged laparoscopic or robotic-assisted urologic major surgery in the present study. Prolonged laparoscopic procedures have been identified as a potential risk factor for hypothermia [ 10 ]. Further studies are needed in surgery of various durations to clarify the thermoregulatory control of remimazolam on core body temperature.…”