Relationship Between Intraoperative Hypothermia and Hyperthermia with Postoperative Pulmonary Infection and Surgical Site Infection in Major Non-cardiac Surgery

Overview

Journal Front Med (Lausanne)

Specialty General Medicine

Date 2024 Aug 27

PMID 39188880

Authors

Qian-Yun Pang

Ya-Jun Yang

Yu-Mei Feng

Shu-Fang Sun

Hong-Liang Liu

Affiliations

Soon will be listed here.

Abstract

Background: Surgical patients often experience intraoperative hypothermia or hyperthermia. However, the relationship of intraoperative hypothermia and hyperthermia with postoperative pulmonary infection (PPI) and surgical site infection (SSI) is unclear. Here, we conducted a retrospective cohort study to address these issues.

Methods: Adult patients who underwent major non-cardiac surgery under general anesthesia were eligible for the study and were recruited. Three indices of core body temperature under hypothermia (<36°C) and hyperthermia (>37.3°C) were calculated as mentioned in the following: absolute value (C), duration of exposure (min), and area under the curve (AUC,°C× min). The outcomes were in-hospital PPI and SSI. The risk-adjusted association of intraoperative hypothermia and hyperthermia with PPI and SSI was determined.

Results: The absolute value (the nadir value of hypothermia and the peak value of hyperthermia) was not associated with PPI and SSI. PPI was associated with (1) duration: hypothermia >90 min [adjusted odds ratio (aOR): 1.425, 95% confidence interval (CI): 1.131-1.796] and hyperthermia >75 min (aOR: 1.395, 95%CI: 1.208-1.612) and (2) AUC: hypothermia >3,198 (aOR: 1.390, 95%CI: 1.128-1.731) and hyperthermia >7,945 (aOR: 2.045, 95%CI: 1.138-3.676). SSI was associated with (1) duration: hypothermia > 195 min (aOR: 2.900, 95%CI: 1.703-4.937) and hyperthermia >75 min (aOR: 1.395, 95%CI: 1.208-1.612) and (2) AUC: hypothermia >6,946 (aOR: 2.665, 95%CI: 1.618-4.390), hyperthermia >7,945 (aOR: 2.619, 95%CI: 1.625-4.220). Interactions were not observed between hyperthermia and hypothermia on the outcomes.

Conclusions: It was observed that intraoperative hypothermia and hyperthermia are associated with postoperative pulmonary infection and surgical site infection in major non-cardiac surgery.

References

Campbell G, Alderson P, Smith A, Warttig S . Warming of intravenous and irrigation fluids for preventing inadvertent perioperative hypothermia. Cochrane Database Syst Rev. 2015; (4):CD009891. PMC: 6769178. DOI: 10.1002/14651858.CD009891.pub2. View

Walters M, Tanios M, Koyuncu O, Mao G, Valente M, Sessler D . Intraoperative core temperature and infectious complications after colorectal surgery: A registry analysis. J Clin Anesth. 2020; 63:109758. DOI: 10.1016/j.jclinane.2020.109758. View

Rice P, Martin E, He J, Frank M, DeTolla L, Hester L . Febrile-range hyperthermia augments neutrophil accumulation and enhances lung injury in experimental gram-negative bacterial pneumonia. J Immunol. 2005; 174(6):3676-85. DOI: 10.4049/jimmunol.174.6.3676. View

Seamon M, Wobb J, Gaughan J, Kulp H, Kamel I, Dempsey D . The effects of intraoperative hypothermia on surgical site infection: an analysis of 524 trauma laparotomies. Ann Surg. 2012; 255(4):789-95. DOI: 10.1097/SLA.0b013e31824b7e35. View

Berrios-Torres S, Umscheid C, Bratzler D, Leas B, Stone E, Kelz R . Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017. JAMA Surg. 2017; 152(8):784-791. DOI: 10.1001/jamasurg.2017.0904. View

Landisch R, Massoumi R, Christensen M, Wagner A . Infectious outcomes of gastroschisis patients with intraoperative hypothermia. J Surg Res. 2017; 215:93-97. DOI: 10.1016/j.jss.2017.03.053. View

Brown M, Curry T, Hyder J, Berbari E, Truty M, Schroeder D . Intraoperative Hypothermia and Surgical Site Infections in Patients with Class I/Clean Wounds: A Case-Control Study. J Am Coll Surg. 2016; 224(2):160-171. DOI: 10.1016/j.jamcollsurg.2016.10.050. View

Brodshaug I, Tettum B, Raeder J . Thermal Suit or Forced Air Warming in Prevention of Perioperative Hypothermia: A Randomized Controlled Trial. J Perianesth Nurs. 2019; 34(5):1006-1015. DOI: 10.1016/j.jopan.2019.03.002. View

Baucom R, Phillips S, Ehrenfeld J, Muldoon R, Poulose B, Herline A . Association of Perioperative Hypothermia During Colectomy With Surgical Site Infection. JAMA Surg. 2015; 150(6):570-5. DOI: 10.1001/jamasurg.2015.77. View

10.

Fernandez-Bustamante A, Frendl G, Sprung J, Kor D, Subramaniam B, Ruiz R . Postoperative Pulmonary Complications, Early Mortality, and Hospital Stay Following Noncardiothoracic Surgery: A Multicenter Study by the Perioperative Research Network Investigators. JAMA Surg. 2016; 152(2):157-166. PMC: 5334462. DOI: 10.1001/jamasurg.2016.4065. View

11.

Obermeyer Z, Samra J, Mullainathan S . Individual differences in normal body temperature: longitudinal big data analysis of patient records. BMJ. 2017; 359:j5468. PMC: 5727437. DOI: 10.1136/bmj.j5468. View

12.

Yi J, Xiang Z, Deng X, Fan T, Fu R, Geng W . Incidence of Inadvertent Intraoperative Hypothermia and Its Risk Factors in Patients Undergoing General Anesthesia in Beijing: A Prospective Regional Survey. PLoS One. 2015; 10(9):e0136136. PMC: 4567074. DOI: 10.1371/journal.pone.0136136. View

13.

Sessler D . Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008; 109(2):318-38. PMC: 2614355. DOI: 10.1097/ALN.0b013e31817f6d76. View

14.

Constantine R, Kenkel M, Hein R, Cortez R, Anigian K, Davis K . The impact of perioperative hypothermia on plastic surgery outcomes: a multivariate logistic regression of 1062 cases. Aesthet Surg J. 2015; 35(1):81-8. DOI: 10.1093/asj/sju022. View

15.

Hasday J, Garrison A, Singh I, Standiford T, Ellis G, Rao S . Febrile-range hyperthermia augments pulmonary neutrophil recruitment and amplifies pulmonary oxygen toxicity. Am J Pathol. 2003; 162(6):2005-17. PMC: 1868125. DOI: 10.1016/S0002-9440(10)64333-7. View

16.

Jildeh T, Okoroha K, Marshall N, Amato C, Trafton H, Muh S . The Effect of Intraoperative Hypothermia on Shoulder Arthroplasty. Orthopedics. 2018; 41(4):e523-e528. DOI: 10.3928/01477447-20180511-02. View

17.

Wang H, Chang Y, Xin M, Hou T, Han L, Zhang R . Hypothermia or hyperthermia, which is associated with patient outcomes in critically ill children with sepsis? -A retrospective study. BMJ Open. 2023; 13(4):e067716. PMC: 10111912. DOI: 10.1136/bmjopen-2022-067716. View

18.

Kushimoto S, Gando S, Saitoh D, Mayumi T, Ogura H, Fujishima S . The impact of body temperature abnormalities on the disease severity and outcome in patients with severe sepsis: an analysis from a multicenter, prospective survey of severe sepsis. Crit Care. 2013; 17(6):R271. PMC: 4057086. DOI: 10.1186/cc13106. View

19.

Tsuchida T, Takesue Y, Ichiki K, Uede T, Nakajima K, Ikeuchi H . Influence of Peri-Operative Hypothermia on Surgical Site Infection in Prolonged Gastroenterological Surgery. Surg Infect (Larchmt). 2016; 17(5):570-6. DOI: 10.1089/sur.2015.182. View

20.

Horan T, Andrus M, Dudeck M . CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008; 36(5):309-32. DOI: 10.1016/j.ajic.2008.03.002. View