Division of Gynecology Surgery, Mayo Clinic, Rochester, Minnesota 55905, USA.
Obstet Gynecol. 2012 Mar;119(3):590-6. doi: 10.1097/AOG.0b013e3182475f8a.
To evaluate intraoperative hypothermia as a predictor for morbidity after open abdominal surgery for ovarian cancer.
This cohort study included 146 women with stage IIIC and IV ovarian cancer who underwent debulking surgery at our institution from January 1, 2001, through December 31, 2003. Hypothermia was defined as end operative temperature lower than 36°C. Early complications (occurring within 30 days of surgery) included: mortality, infectious morbidities, cardiovascular events, venous thromboembolic (VTE) events, anastomotic leak, readmission, and reoperation. Survival was also evaluated. Logistic regression models were used to adjust for known confounders.
The mean age was 63.9 ± 11.7 years; 46 (32%) patients had a body mass index higher than 30; mean operative time was 239 ± 85 minutes. There were five deaths perioperatively, all in the hypothermic group. Hypothermia was associated with an increased risk of any early complications (34 [42.0%] compared with 11 [16.9%]) with an adjusted odds ratio (OR) of 3.40 (95% confidence interval [CI] 1.48-8.33). For individual complications, hypothermic patients were at higher risk for VTE events with an adjusted OR of 3.53 (95% CI 1.02-16.44); infectious morbidity with an adjusted OR of 2.99 (95% CI 0.97-11.35); and reoperation with an adjusted OR of 4.96 (95% CI 0.80-95.7). The overall survival was shorter in hypothermic group with a median of 34 compared with 45 months (P=.045); this remained significant for an optimally resected subgroup with a median overall survival of 40 compared with 48 months (P=.049).
Surgical hypothermia is an independent predictor of early perioperative complications and overall survival after cytoreductive surgery for ovarian cancer. This is a critically important finding, because maintaining normothermia is an inexpensive modifiable factor, which could result in reduced morbidity.
评估术中低体温作为卵巢癌开腹手术术后发病率的预测指标。
本队列研究纳入了 2001 年 1 月 1 日至 2003 年 12 月 31 日期间在我院接受减瘤手术的 146 例 IIIC 期和 IV 期卵巢癌患者。术中低体温定义为终末手术温度低于 36°C。早期并发症（术后 30 天内发生）包括：死亡率、感染性发病率、心血管事件、静脉血栓栓塞（VTE）事件、吻合口漏、再入院和再次手术。还评估了生存情况。使用逻辑回归模型调整已知混杂因素。
平均年龄为 63.9 ± 11.7 岁；46（32%）例患者体重指数大于 30；平均手术时间为 239 ± 85 分钟。围手术期有 5 例死亡，均发生在低体温组。低体温与任何早期并发症的风险增加相关（34 [42.0%] 与 11 [16.9%]），调整后的优势比（OR）为 3.40（95%置信区间 [CI] 1.48-8.33）。对于个别并发症，低体温患者 VTE 事件的风险更高，调整后的 OR 为 3.53（95%CI 1.02-16.44）；感染发病率的调整 OR 为 2.99（95%CI 0.97-11.35）；再次手术的调整 OR 为 4.96（95%CI 0.80-95.7）。低体温组的总生存率更短，中位数为 34 个月，而 45 个月（P=.045）；对于最佳切除亚组，中位总生存率为 40 个月，而 48 个月（P=.049），这仍然具有统计学意义。
卵巢癌肿瘤细胞减灭术后，术中低体温是围手术期早期并发症和总生存率的独立预测指标。这是一个非常重要的发现，因为维持正常体温是一种廉价的可改变因素，可降低发病率。
