Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo.
Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo.
J Thorac Cardiovasc Surg. 2024 Jun;167(6):1979-1989.e1. doi: 10.1016/j.jtcvs.2023.10.031. Epub 2023 Oct 21.
Inadvertent perioperative hypothermia has been associated with poor surgical outcomes. The purpose of this study was to evaluate the incidence and associated postoperative complications of inadvertent perioperative hypothermia in patients undergoing robotic-assisted thoracic surgery lung resections.
This was a single-center, retrospective cohort study evaluating all consecutive patients who underwent robotic-assisted thoracic surgery lung resection between January 1, 2021, and November 30, 2022. Temperatures were measured at 5 time points: preprocedure unit, anesthesia induction, 30 minutes postinduction, extubation, and recovery room arrival. Temperature changes were calculated at each interval. Adjusted and unadjusted comparison was performed between those who experienced varying levels of inadvertent perioperative hypothermia (Hypothermia I: <36 °C, Hypothermia II: <35.5 °C, and Hypothermia III: <35 °C) and those who did not.
A total of 313 patients were included, and 201 (64.2%) lobectomies, 50 (16.0%) segmentectomies, and 62 (19.8%) wedge resections were performed. Across all patients, 291 (93.0%) had a temperature less than 36 °C, 195 (62.3%) had a temperature less than 35.5 °C, and 100 (31.9%) had a temperature less than 35.0 °C. Patients experienced significant temperature change at all intervals (P < .001), with the greatest loss occurring during the preprocedure interval (between leaving preprocedure unit and anesthesia induction). On adjusted analysis, patients who experienced inadvertent perioperative hypothermia less than 35.5 °C were older (odds ratio, 1.03; 95% CI, 1.01-1.05), had lower body mass index (odds ratio, 0.95; 95% CI, 0.87-0.98), and had increasing operative time (odds ratio, 1.00; 95% CI, 1.00-1.01). Patients who experienced inadvertent perioperative hypothermia had higher risk-adjusted rates of overall morbidity and infectious postoperative complications.
The majority of patients undergoing robotic-assisted thoracic surgery lung resections experience some degree of inadvertent perioperative hypothermia and have associated increased rates of 30-day morbidity. Structured and interval-specific interventions should be implemented to decrease rates of inadvertent perioperative hypothermia and subsequent complications.
术中意外低体温与不良手术结果有关。本研究旨在评估机器人辅助胸腔镜肺切除术中意外术中低体温的发生率及其与术后并发症的关系。
这是一项单中心、回顾性队列研究，评估了 2021 年 1 月 1 日至 2022 年 11 月 30 日期间所有接受机器人辅助胸腔镜肺切除术的连续患者。在 5 个时间点测量温度：术前单位、麻醉诱导、诱导后 30 分钟、拔管和恢复室到达。计算每个间隔的温度变化。在经历不同程度的术中意外低体温（低体温 I：<36°C，低体温 II：<35.5°C，低体温 III：<35°C）的患者与未经历的患者之间进行调整和未调整的比较。
共纳入 313 例患者，行肺叶切除术 201 例（64.2%），行肺段切除术 50 例（16.0%），行楔形切除术 62 例（19.8%）。所有患者中，291 例（93.0%）体温低于 36°C，195 例（62.3%）体温低于 35.5°C，100 例（31.9%）体温低于 35.0°C。患者在所有间隔均经历显著的温度变化（P<.001），最大的损失发生在术前间隔（离开术前单位至麻醉诱导期间）。在调整分析中，术中意外低体温<35.5°C 的患者年龄更大（优势比，1.03；95%CI，1.01-1.05），体重指数更低（优势比，0.95；95%CI，0.87-0.98），手术时间延长（优势比，1.00；95%CI，1.00-1.01）。经历术中意外低体温的患者总体发病率和感染性术后并发症的风险调整发生率更高。
大多数接受机器人辅助胸腔镜肺切除术的患者经历一定程度的术中意外低体温，并且 30 天发病率增加。应实施有针对性和间隔特异性的干预措施，以降低术中意外低体温和随后并发症的发生率。
