Department of Value Based Healthcare, St. Antonius Hospital, Nieuwegein, The Netherlands.
Department of Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands.
Surg Infect (Larchmt). 2021 Oct;22(8):803-809. doi: 10.1089/sur.2020.229. Epub 2021 Feb 9.
Current guidelines recommend maintaining intra-operative normothermia to avoid surgical site infections (SSI) after colorectal cancer surgery. The aim of this study was to assess whether compliance with normothermia as part of temperature management measures is an effective strategy to reduce post-operative SSI and complications. This was a cohort study of patients undergoing surgery for primary colorectal cancer in 2011-2017 in a large teaching hospital in which temperature management using the Bair Hugger™ system (3M™ Center, St. Paul, MN) was standard care. Data from the prospective Dutch Surgical Audit (DCRA) database were complemented by highly granular intra-operative central body temperature data. A multivariable logistic regression model was used. A total of 1,015 patients undergoing surgery for primary colorectal cancer were included. Temperature outcomes for the entire study cohort were as follows: mean temperature was 36.3°C (standard deviation [SD] ±0.5°C), median temperature nadir was 35.8°C (interquartile range [IQR] 35.6°C-36.1°C), median percentage of time at nadir was 2.0% (IQR 0.8%-10.7%), and median percentage of time less than 36.0°C was 1.0% (IQR 0.0%-33.3%). Thirty-day SSI rate was 10% (n = 101). Logistic regression models adjusting for gender, diabetes mellitus, body mass index (BMI), rectal cancer, duration of surgery, open surgery, emergency surgery, and period of surgery showed no association between any of the four temperature outcomes and SSI. Multivariable analysis also failed to show an association between intra-operative hypothermia and 30-day complications, mortality, or re-admission. In a hospital in which temperature management is standard care, intra-operative hypothermia and SSI rates in patients undergoing colorectal cancer surgery were low. Compliance with normothermia appears to be an effective strategy to reduce SSI.
目前的指南建议在结直肠癌手术后保持术中正常体温，以避免手术部位感染（SSI）。本研究旨在评估作为体温管理措施的一部分，遵守正常体温是否是降低术后 SSI 和并发症的有效策略。这是一项对 2011 年至 2017 年期间在一家大型教学医院接受原发性结直肠癌手术的患者进行的队列研究，该医院在使用 Bair Hugger™系统（3M™ Center，St. Paul，MN）进行体温管理时，标准护理。前瞻性荷兰外科审计（DCRA）数据库的数据由术中核心体温的高度细化数据补充。使用多变量逻辑回归模型。共纳入 1015 例接受原发性结直肠癌手术的患者。整个研究队列的温度结果如下：平均温度为 36.3°C（标准差[SD]±0.5°C），中位数体温最低值为 35.8°C（四分位距[IQR]35.6°C-36.1°C），中位数时间的最低百分比为 2.0%（IQR 0.8%-10.7%），中位数时间小于 36.0°C 的百分比为 1.0%（IQR 0.0%-33.3%）。30 天 SSI 发生率为 10%（n=101）。调整性别、糖尿病、体重指数（BMI）、直肠癌、手术持续时间、开放手术、急诊手术和手术期的逻辑回归模型显示，四个温度结果与 SSI 之间均无关联。多变量分析也未能显示术中低体温与 30 天并发症、死亡率或再入院之间存在关联。在一家标准体温管理的医院中，接受结直肠癌手术的患者术中低体温和 SSI 发生率较低。遵守正常体温似乎是降低 SSI 的有效策略。
