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Continuous Intraoperative Temperature Measurement and Surgical Site Infection Risk: Analysis of Anesthesia Information System Data in 1,008 Colorectal Procedures
Genevieve B Melton*1, Jon D Vogel*2, Brian R Swenson*3, Feza H Remzi*2, David A Rothenberger1, Elizabeth C Wick*4
1University of Minnesota, Minneapolis, MN;2Cleveland Clinic Foundation, Cleveland, OH;3Mercy Clinic General and Specialty Surgery, Columbia, MO;4Johns Hopkins Medical Institutions, Baltimore, MD

OBJECTIVE(S): To investigate associations of intraoperative temperature and surgical site infection (SSI) in colorectal surgery with anesthesia information system (AIS) data.
METHODS: Continuously measured intraoperative AIS temperature data at a large tertiary center for one year were linked to all adult abdominal colorectal cases and evaluated with American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) criteria. After cleaning spurious AIS values, univariate and multivariate analyses of SSI to descriptive temperature statistics, absolute and relative temperature threshold times, and other variables were performed.
RESULTS: Overall, 1,008 patients (48% female, median age 53 years) underwent major colorectal procedures (7% emergent, 72% open, 173±95 minutes mean procedure time) with median intraoperative temperature 36.0 using active re-warming in 92% and one-hour presurgical antibiotic administration in 91%. 30-day SSI and organ/space infection rates were 17.4%(175) and 8.5%(86). Maximum, minimum, ending and median temperatures were similar (36.6 vs.36.5, 34.9 vs.35.0, 36.4 vs. 36.2, 36.1 vs.36.0, p=NS) and percent minutes using incremental cutoffs failed to correlate SSI with temperature. Absolute minutes for higher temperature cutoffs correlated with SSI, due to longer procedure times. On multivariate analysis, significant factors associated with SSI included preoperative diabetes (p=0.02), open approach (p=0.04) and blood loss (p=0.01).
CONCLUSIONS: Although an accepted process measure, highly-granular AIS temperature data failed to demonstrate improved SSI outcomes with normothermia, and SSI prevention efforts should focus on more efficacious interventions.


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