Normothermia After Gastrointestinal Surgery: Holy Grail or False Idol?
*Simon J Lehtinen, *Georgiana Onicescu, *Kathy Kuhn, David J Cole, *Nestor F Esnaola
Medical University of South Carolina, Charleston, SC
OBJECTIVES: Although active warming during colorectal (CR) surgery decreases surgical site infections (SSIs), there is limited evidence that immediate postoperative hypothermia (IPH, T< 36°C) per se is associated with SSIs. Nonetheless, hospitals currently report postoperative normothermia rates after CR surgery as part of CMS’ Surgical Care Improvement Project.
METHODS: We conducted a nested, matched, case-control study to analyze the association between IPH and SSIs after gastrointestinal (GI) surgery. Cases consisted of all GI surgery patients (pts) entered into our National Surgical Quality Improvement Program (NSQIP) database between 3/2006-3/2009 who developed SSIs. Patient/surgery risk factors for SSI were obtained from the NSQIP database. Perioperative temperature/antibiotic/glucose data was obtained from medical records. Cases/controls were compared using univariate random effects regression models. Independent risk factors for SSIs were identified using multivariate random effects logistic regression models.
RESULTS: 146 cases and 323 matched controls were identified; 82% of pts underwent non-CR surgery. Cases/controls were similar with respect to percentage of pts with IPH (29.4% v. 34.7%, respectively, P=0.27). Emergent surgery and/or contaminated wounds were associated with lower rates of IPH. Independent risk factors for SSIs were diabetes, surgical complexity, and small bowel/non-laparoscopic surgery. There was no association between IPH and SSIs, even when controlling for pt/surgery/wound-characteristics and perioperative antibiotics/glucose (adjusted OR, 1.14; 95% CI, 0.65-2.00; P=0.66).
CONCLUSIONS: IPH is not associated with SSIs after GI surgery. Pay-for-reporting measures focusing on normothermia after CR surgery may be of limited clinical value. Trials to determine the benefit of active warming during non-CR GI surgery are warranted.