Billeter Adrian T, Hohmann Samuel F, Druen Devin, Cannon Robert, Polk Hiram C
Hiram C. Polk Jr. MD Department of Surgery, University of Louisville School of Medicine, Louisville, KY; University of Louisville Hospital, Louisville, KY.
University HealthSystem Consortium, Chicago, IL.
Surgery. 2014 Nov;156(5):1245-52. doi: 10.1016/j.surg.2014.04.024. Epub 2014 Jun 16.
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.
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.
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.
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.
在多达7%的择期结直肠手术中会出现体温过低的情况，这是一种被低估的并发症和死亡风险因素。仅对体温过低的患者进行复温不足以预防此类不良事件。我们调查了择期手术后体温过低（<35°C）患者的预后，并将他们与匹配度高的非体温过低的手术患者进行比较，以更好地确定体温过低对外科手术预后的影响，并识别体温过低的独立危险因素。
我们查询了大学卫生系统联盟（UHC）数据库，以获取2008年10月至2012年3月间非故意体温过低的择期手术患者，共识别出707例患者。排除标准为故意低温、年龄<18岁或入院当天死亡。另外，为验证体温过低编码的准确性，我们查阅了所有数据已提交给UHC的路易斯维尔大学医院体温过低患者的病历。
UHC中所有体温过低编码的患者确实都是非故意体温过低。接受择期手术的体温过低患者死亡率增加了4倍（17.0%对4.0%；P<.001），并发症发生率翻倍（26.3%对13.9%；P<.001），其中败血症和中风增加最多。体温过低的几个独立危险因素在术前是可以改善的：贫血、慢性肾功能损害和意外体重减轻。入院时的疾病严重程度、年龄>65岁、男性和神经疾病也是危险因素。
体温过低与死亡率和并发症发生率增加有关。术前对这些危险因素进行预防性治疗，并对“高危”人群采取积极的升温措施，可能会降低择期手术中与体温过低相关的发病率和死亡率。应进行随机对照试验，以评估积极升温措施对高危人群的影响。
