Hypothermia Is Associated with Surgical Site Infection in Cytoreductive Surgery with Hyperthermic Intra-Peritoneal Chemotherapy

Surg Infect (Larchmt). 2018 Aug/Sep;19(6):618-621. doi: 10.1089/sur.2018.063. Epub 2018 Jul 25.

Abstract

Background: Maintenance of peri-operative normothermia remains a global quality metric for hospitals. Hypothermia is associated with surgical site infections (SSIs) in colorectal surgery. Patients undergoing cytoreductive surgery (CRS) with hyperthermic intra-peritoneal chemotherapy (HIPEC) can experience multiple complications post-operatively. We sought to investigate the association of peri-operative hypothermia with SSIs in patients undergoing CRS/HIPEC at our institution.

Patients and methods: Patients undergoing CRS/HIPEC from 2009-2017 were identified retrospectively from a prospectively collected institutional database. Hypothermia defined as less than 36.0°C in accordance with the Agency for Healthcare Research and Quality metric. Regression analyses were performed with SSIs diagnosed within 30 days post-operatively as the primary outcome.

Results: A total of 170 patients were identified, 14 (8.2%) of whom developed an SSI. Patients who developed an SSI experienced lower median temperatures (p = 0.027) and a greater percentage of operative time in hypothermia (p = 0.008). On a multivariable analysis adjusting for known risk factors for SSI, the percentage of operative time in hypothermia (odds ratio [OR] 1.04, 95% confidence interval [CI] 1.01-1.07, p = 0.008) was the only parameter associated with SSI within 30 days post-operatively.

Conclusion: Hypothermia is associated with the development of SSIs in patients undergoing CRS/HIPEC. Our findings suggest that minimizing peri-operative temperatures to less than 36.0°C may decrease peri-operative SSI in this patient population.

Keywords: anesthesiology; surgery; surgical site infection.

MeSH terms

  • Cytoreduction Surgical Procedures / adverse effects*
  • Cytoreduction Surgical Procedures / methods
  • Female
  • Gastrointestinal Neoplasms / therapy
  • Humans
  • Hyperthermia, Induced / adverse effects*
  • Hyperthermia, Induced / methods
  • Hypothermia / complications*
  • Male
  • Middle Aged
  • Retrospective Studies
  • Surgical Wound Infection / etiology*