Adrian T Billeter1, Samuel F Hohmann2, Devin Druen3, Robert Cannon3, Hiram C Polk4. 1. Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY; University of Louisville Hospital, Louisville, KY. Electronic address: adrianbilleter@gmail.com. 2. University HealthSystem Consortium, Chicago, IL. 3. Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY; University of Louisville Hospital, Louisville, KY. 4. Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY; University of Louisville Hospital, Louisville, KY. Electronic address: hcpolk01@louisville.edu.
Abstract
INTRODUCTION: Hypothermia occurs in as many as 7% of elective colorectal operations and is an underestimated risk factor for complications and death. Rewarming of hypothermic patients alone is not sufficient to prevent such adverse events. We investigated the outcomes of patients who became hypothermic (<35°C) after elective operations and compared them with closely matched, nonhypothermic operative patients to better define the impact of hypothermia on surgical outcomes, as well as to identify independent risk factors for hypothermia. METHODS: We queried the University HealthSystem Consortium (UHC) database for elective operative patients who became unintentionally hypothermic from October 2008 to March 2012, and identified 707 patients. Exclusion criteria were deliberate hypothermia, age <18 years, or death on day of admission. Separately, to validate the accuracy of hypothermia coding, we reviewed the hospital charts of all University of Louisville Hospital patients with hypothermia whose data were submitted to UHC. RESULTS: All patients from UHC with a code for hypothermia were indeed unintentionally hypothermic. Hypothermic patients undergoing elective operations experienced a 4-fold increase in mortality (17.0% vs 4.0%; P < .001) and a doubled complication rate (26.3% vs 13.9%; P < .001), in which sepsis and stroke increased the most. Several independent risk factors for hypothermia were amenable to preoperative improvement: anemia, chronic renal impairment, and unintended weight loss. Severity of illness on admission, age >65 years, male sex, and neurologic disorders also were risk factors. CONCLUSION: Hypothermia is associated with an increased rate of mortality and complications. Preventive treatment of these risk factors before operation and aggressive warming measures in the "at risk" population may decrease hypothermia-related morbidity and mortality in elective operations. Randomized-controlled trials should be conducted to evaluate the impact of aggressive warming measures in the at-risk population.
INTRODUCTION:Hypothermia occurs in as many as 7% of elective colorectal operations and is an underestimated risk factor for complications and death. Rewarming of hypothermicpatients alone is not sufficient to prevent such adverse events. We investigated the outcomes of patients who became hypothermic (<35°C) after elective operations and compared them with closely matched, nonhypothermic operative patients to better define the impact of hypothermia on surgical outcomes, as well as to identify independent risk factors for hypothermia. METHODS: We queried the University HealthSystem Consortium (UHC) database for elective operative patients who became unintentionally hypothermic from October 2008 to March 2012, and identified 707 patients. Exclusion criteria were deliberate hypothermia, age <18 years, or death on day of admission. Separately, to validate the accuracy of hypothermia coding, we reviewed the hospital charts of all University of Louisville Hospital patients with hypothermia whose data were submitted to UHC. RESULTS: All patients from UHC with a code for hypothermia were indeed unintentionally hypothermic. Hypothermicpatients undergoing elective operations experienced a 4-fold increase in mortality (17.0% vs 4.0%; P < .001) and a doubled complication rate (26.3% vs 13.9%; P < .001), in which sepsis and stroke increased the most. Several independent risk factors for hypothermia were amenable to preoperative improvement: anemia, chronic renal impairment, and unintended weight loss. Severity of illness on admission, age >65 years, male sex, and neurologic disorders also were risk factors. CONCLUSION:Hypothermia is associated with an increased rate of mortality and complications. Preventive treatment of these risk factors before operation and aggressive warming measures in the "at risk" population may decrease hypothermia-related morbidity and mortality in elective operations. Randomized-controlled trials should be conducted to evaluate the impact of aggressive warming measures in the at-risk population.
Authors: Adrian T Billeter; Jason Hellmann; Henry Roberts; Devin Druen; Sarah A Gardner; Harshini Sarojini; Susan Galandiuk; Sufan Chien; Aruni Bhatnagar; Matthew Spite; Hiram C Polk Journal: FASEB J Date: 2014-09-17 Impact factor: 5.191
Authors: Ravi Oodit; Bruce M Biccard; Eugenio Panieri; Adrian O Alvarez; Marianna R S Sioson; Salome Maswime; Viju Thomas; Hyla-Louise Kluyts; Carol J Peden; Hans D de Boer; Mary Brindle; Nader K Francis; Gregg Nelson; Ulf O Gustafsson; Olle Ljungqvist Journal: World J Surg Date: 2022-05-31 Impact factor: 3.282
Authors: Eero Pesonen; Marja Silvasti-Lundell; Tomi T Niemi; Riku Kivisaari; Juha Hernesniemi; Marja-Tellervo Mäkinen Journal: J Clin Monit Comput Date: 2018-11-22 Impact factor: 2.502
Authors: Christopher Mikhail; Zach Pennington; Paul M Arnold; Darrel S Brodke; Jens R Chapman; Norman Chutkan; Michael D Daubs; John G DeVine; Michael G Fehlings; Daniel E Gelb; George M Ghobrial; James S Harrop; Christian Hoelscher; Fan Jiang; John J Knightly; Brian K Kwon; Thomas E Mroz; Ahmad Nassr; K Daniel Riew; Lali H Sekhon; Justin S Smith; Vincent C Traynelis; Jeffrey C Wang; Michael H Weber; Jefferson R Wilson; Christopher D Witiw; Daniel M Sciubba; Samuel K Cho Journal: Global Spine J Date: 2020-01-06