术中低体温对基于假体的乳房重建感染发生率的影响。
Impact of Intraoperative Hypothermia on Incidence of Infection in Implant-Based Breast Reconstruction.
机构信息
From the Division of Plastic and Reconstructive Surgery, Virginia Commonwealth University Health System.
Virginia Commonwealth University School of Medicine.
出版信息
Plast Reconstr Surg. 2024 Jan 1;153(1):35-44. doi: 10.1097/PRS.0000000000010574. Epub 2023 Apr 20.
BACKGROUND
Infection following implant-based breast reconstruction can lead to devastating complications. Risk factors for infection include smoking, diabetes, and obesity. Intraoperative hypothermia may represent another modifiable risk factor. This study analyzed the effect of hypothermia in postmastectomy immediate implant-based reconstruction on postoperative surgical-site infection (SSI).
METHODS
This was a retrospective review of 122 patients with intraoperative hypothermia, defined as less than 35.5°C, and 106 normothermic patients who underwent postmastectomy implant-based reconstruction between 2015 and 2021. Demographics, comorbidities, smoking status, hypothermia (and its duration), and length of surgery were collected. The primary outcome was SSI. Secondary outcomes included reoperation and delayed wound healing.
RESULTS
A total of 185 patients (81%) underwent staged reconstruction with tissue expander placement and 43 patients (18.9%) had a direct-to-implant procedure. Over half (53%) of the patients experienced intraoperative hypothermia. In the hypothermic group, a higher proportion of patients had SSIs (34.4% versus 17% of normothermic patients; P < 0.05) and wound healing complications (27.9% versus 16%; P < 0.05). Intraoperative hypothermia predicted SSI (OR, 2.567; 95% CI, 1.367 to 4.818; P < 0.05) and delayed wound healing (OR, 2.023; 95% CI, 1.053 to 3.884; P < 0.05). Longer duration of hypothermia significantly correlated with SSI, with an average 103 minutes versus 77 minutes ( P < 0.05).
CONCLUSIONS
This study demonstrates that intraoperative hypothermia is a significant risk factor for postoperative infection in postmastectomy implant-based breast reconstruction. Maintaining strict normothermia during implant-based breast reconstruction procedures may improve patient outcomes by reducing the risk of postoperative infection and delayed wound healing.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.
背景
植入物乳房再造术后感染可导致严重的并发症。感染的危险因素包括吸烟、糖尿病和肥胖。术中低体温可能是另一个可改变的危险因素。本研究分析了乳房切除术后即刻植入物重建术中低体温对术后手术部位感染（SSI）的影响。
方法
这是一项回顾性研究，纳入了 2015 年至 2021 年间接受乳房切除术后植入物重建术的 122 例术中低体温（定义为<35.5°C）和 106 例正常体温患者。收集了人口统计学、合并症、吸烟状况、低体温（及其持续时间）和手术时间等数据。主要结局是 SSI。次要结局包括再次手术和延迟伤口愈合。
结果
共有 185 例（81%）患者行分期重建，其中 122 例行组织扩张器置入术，43 例（18.9%）患者行直接植入术。超过一半（53%）的患者出现术中低体温。在低体温组中，SSI 发生率较高（34.4%比正常体温组的 17%；P<0.05）和伤口愈合并发症发生率较高（27.9%比 16%；P<0.05）。术中低体温预测 SSI（OR，2.567；95%CI，1.367 至 4.818；P<0.05）和延迟伤口愈合（OR，2.023；95%CI，1.053 至 3.884；P<0.05）。低体温持续时间较长与 SSI 显著相关，平均 103 分钟比 77 分钟（P<0.05）。
结论
本研究表明，术中低体温是乳房切除术后植入物乳房再造术后感染的一个显著危险因素。在植入物乳房重建手术中保持严格的正常体温可能通过降低术后感染和延迟伤口愈合的风险来改善患者的结局。
临床问题/证据水平：风险，II 级。
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