C4CONSEQUENCES OF HYPOTHERMIA - COHORT STUDIES

Study detailsPatient detailsFactors adjusted forAnaesthesia/surgeryFurther details
Surgical wound infection
Flores Maldonado 2001; prospective cohort study; country Mexico; total N=290Age: 40 (SD 12) years; ASA gradeI (77%) and II (23%); temperature measured at tympanic membrane; surgical wound infectionAge, diabetes mellitus precedents, prophylactic antibiotic, non- prophylactic antibiotic, wound drains, surgical time, mild IPH (7). Only one hospital so constant.Type of anaesthesia: general; type of surgery: abdominal; theatre temperatureClean-contaminated surgery only; surgical time <120 min; hospital stay <2 days; positive or negative precedents of diabetes. Exclusions: blood transfusion 30 d before or during operation or 30 d after. PACU temperature >38 °C; respiratory or ear infections; single hospital. SWI task force definition+positive cultures. All had major elective surgery. 20 patients hadSWI. Cholecystectomy.
Walz 2006; retrospective cohort study; country USA; total N=1472Age: median 57 (range 18–96) years; ASA gradeI (6%), II (46%), III (40%), IV (7%), V (1%); temperature measured at not stated; surgical wound infectionPerioperative transfusion, intraoperative temperature nadir, presence of current infection, wound class, surgical time (> or <4h), perioperative antibiotics (6)Type of anaesthesia: mixed general/regional/combined; type of surgery: abdominal; theatre temperature not statedMulti-centre study. Data from University database Sept–Dec 2002; excluded if HLoS was >3SD from median (n=26). Surgery of small bowel and colon only.
Elective/urgent/emergent surgery. 51% bowel prep.; Rate of SSI: Clean- contaminated wounds 7.9% of 1233, contaminated 12% of 125, dirty/infected 20.4% of 49 (total 122). 3% partients had current infection.
Morbid cardiac event
Frank 1993; prospective cohort study; country USA; total N=100Age: 65 years mean (SEM 2); 35–94 years; ASA grade; temperature measured at sublingual reliable; morbid cardiac eventAge >65y; gender; preoperative diabetes; smoking; hypertension; beta blockade; angina; history of MI; prior coronary artery bypass surgery; type of anaesthesia; temperature on admission to ICU; postoperative shivering; postop haemocrit; intraop blood lossType of anaesthesia: mixed general/regional groups; type of surgery: vascular; theatre temperature 21 to 24 °CPatients from RCT of anaesthesia type. Multicentre study. Lower extremity vascular surgery (expected high incidence of CA disease and perioperative morbidity). Exclusions: left bundle branch block, pacemaker rhythm, LV hypertrophy with strain pattern. Sublingual temperatures placed by experienced nurses. No warming apart from fluids. Outcome myocardial ischaemia. 21 events.
Blood
Stapelfeldt 1996; retrospective cohort study; country USA; total N=100Age: not stated; ASA grade not stated; temperature measured at not stated; blood transfusion intraoperativelyUnclear: probably baseline platelet count, Hgb levels, intraoperative PC and Hgb, duration of operative stages x 3, time in hypothermic state x 2 (minimum 9)Type of anaesthesia: not stated; type of surgery: liver transplant; theatre temperature not statedAbstract - limited details. 100 most recent liver transplant records from the VA Medical Center. Average number of units transfused per case hour was outcome measure.
Vorrakitpokatorn 2006; prospective cohort study; country Thailand; total N=128Age: 48.9 y (SD 13.54); 12.5% >65y; ASA gradeASA I 59%; ASA II 31%; ASA III 9%; temperature measured at tympanic membrane; blood transfusion intraoperativelyAge, duration of surgery, volume of irrigation fluid, intraoperative hypothermia (4)Type of anaesthesia: general; type of surgery: urology; theatre temperature not statedAll patients had first time surgery for percutaneous nephrolithotomy. All patients had antibiotics. Some patients appeared to have FAW; Intraoperative blood transfusion required for 16% of patients (19) and the maxumum transfusion was 2 units in 7.6% patients.
Blood transfusion postoperatively
Vorrakitpokatorn 2006; prospective cohort study; country Thailand; total N=128Age: 48.9 y (SD 13.54); 12.5% >65y; ASA gradeASA I 59%; ASA II 31%; ASA III 9%; temperature measured at tympanic membrane; blood transfusion postoperativelyAge, duration of surgery, intraoperative transfusion, volume of irrigation fluid, postoperative fever, intraoperative hypothermia (5)Type of anaesthesia: general; type of surgery: urology; theatre temperature not statedAll patients had first time surgery for percutaneous nephrolithotomy. All patients had antibiotics. Some patients appeared to have FAW. Postoperative blood transfusion required for 20.2% of patients (26).
Death
Abelha 2005; prospective cohort study; country Portugal; total N=185Age: ; ASA gradeASA I 3%, ASA II 39%, ASA III 49%, ASA IV 10%.; temperature measured at tympanic membrane; deathTemperature on admission, SAPS II, magnitude of surgery, type of surgery, ICU length of stay, hospital length of stay, BMI, body weight (8)Type of anaesthesia: mixed general/regional groups; type of surgery: non-cardiac; theatre temperature 20–22°C (not adjusted for)14 deaths
Bush 1995; part prospective part retrospective study; country USA; total N=262Age: 70.3 (SD 1.3) and 73.1 (SD 1.0); ASA grade not stated; temperature measured at pulmonary artery; deathNorepinephrine therapy, dobutamine therapy, acute MI, multiple organ dysfunctions (4). Some other variables may have been used but were non-significant. Unclear if IPH includedType of anaesthesia: general; type of surgery: abdominal aortic aneurysms; theatre temperature not statedData collected from ICU/PACU patients following elective aortic aneurysm repairs. Postop data were collected prospectively. All patients with T<36.0 were rewarmed in ICU. In hospital mortality rate. 4.2% N= 11
Janczyk 2004; retrospective cohort study; country USA; total N=100Age: 74 (SD 8.6) years; ASA grade not stated; temperature measured at not stated; deathAge, gender, blood volume transfused, crystalloid volume, intraoperative base deficit, lowest intraop temperature, lowest intraop systolic blood pressure, preop haemoglobin, lowest preop bp, operating room time (10)Type of anaesthesia: not stated; type of surgery: abdominal aortic aneurysms; theatre temperature not statedSurgery for ruptured aortic aneurysm; 70% men. Emergency surgery; 47 deaths
ICU length of stay
Abelha 2005; prospective cohort study; country Portugal; total N=185Age: ; ASA gradeASA I 3%, ASA II 39%, ASA III 49%, ASA IV 10%.; temperature measured at tympanic membrane; ICU length of stayTemperature on admission, previous temperature in ward, ASA, SAPS II, magnitude of surgery, type of anaesthesia, use of temperature monitoring, use of warming technique, total IVcrystalloids, total packed erythrocytes, duration of anaethesia, BMI (9)Type of anaesthesia: mixed general/regional groups; type of surgery: non-cardiac; theatre temperature 20–22 °C (not adjusted for)Outcome measured was number of patients with length of stay longer than 2 days, of which 25.4% (n=47) had this outcome.
Hospital length of stay
Bush 1995; part prospective part retrospective study; country USA; total N=262Age: 70.3 (SD 1.3) and 73.1 (SD 1.0); ASA gradenot stated; temperature measured at pulmonary artery; hospital length of stayMultiple organ dysfunction, aneurysm diameter, low body temperature (3). Some other variables may have been used but were non-significant,Type of anaesthesia: general; type of surgery: abdominal aortic aneurysms; theatre temperature not statedData collected from ICU/PACU patients following elective aortic aneurysm repairs. Postop data were collected prospectively. All patients with T<36.0 were rewarmed in ICU.; Outcome measured was prolonged hospital length of stay, but 'prolonged' not defined
Selldén 1999; prospective cohort study; country Sweden; total N= 75Age: 49 (SD 0.7) and 50 (0.5) years; ASA gradeI only; temperature measured at pulmonary artery and rectal; hospital length of stayAge, height, weight, gender, baseline temperature, awakening temperature, duration of surgery, amino acids (8)Type of anaesthesia: general; type of surgery: abdominal; theatre temperature 20 to 23 °CPatients from quasi RCT and RCT+non-randomised patients. General abdominal surgery (26/75) and hysterectomy. Amino Acid treated group HLoS 6.4 (SD 2) days; control 8.2 (SD 4).
Vorrakitpokatorn 2006; prospective cohort study; country Thailand; total N=128Age: 48.9 y (SD 13.54); 12.5% >65y; ASA gradeASA I 59%; ASA II 31%; ASA III 9%; temperature measured at tympanic membrane; hospital length of stayAge, duration of surgery, intraoperative blood transfusion, volume of irrigation fluid, postoperative blood transfusion, postoperative fever, intraoperative hypothermia (7)Type of anaesthesia: general; type of surgery: urology; theatre temperature not statedAll patients had first time surgery for percutaneous nephrolithotomy. All patients had antibiotics. Some patients appeared to have FAW. Postoperative length of stay reported as number of patients with LoS ≥ 5 days; 57/117 (49%) had longer stay.

From: APPENDIX C, CHARACTERISTICS OF INCLUDED STUDIES

Cover of The Management of Inadvertent Perioperative Hypothermia in Adults
The Management of Inadvertent Perioperative Hypothermia in Adults [Internet].
NICE Clinical Guidelines, No. 65.
National Collaborating Centre for Nursing and Supportive Care (UK).
Copyright © 2008, National Collaborating Centre for Nursing and Supportive Care.

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