Background Mild perioperative hypothermia, which is common duringmajor surgery, may promote surgical-wound infection by triggeringthermoregulatory vasoconstriction, which decreases subcutaneousoxygen tension. Reduced levels of oxygen in tissue impair oxidativekilling by neutrophils and decrease the strength of the healingwound by reducing the deposition of collagen. Hypothermia alsodirectly impairs immune function. We tested the hypothesis thathypothermia both increases susceptibility to surgical-woundinfection and lengthens hospitalization.
Methods Two hundred patients undergoing colorectal surgery wererandomly assigned to routine intraoperative thermal care (thehypothermia group) or additional warming (the normothermia group).The patients' anesthetic care was standardized, and they wereall given cefamandole and metronidazole. In a double-blind protocol,their wounds were evaluated daily until discharge from the hospitaland in the clinic after two weeks; wounds containing culture-positivepus were considered infected. The patients' surgeons remainedunaware of the patients' group assignments.
Results The mean (±SD) final intraoperative core temperaturewas 34.7±0.6°C in the hypothermia group and 36.6±0.5°Cin the normothermia group (P<0.001). Surgical-wound infectionswere found in 18 of 96 patients assigned to hypothermia (19percent) but in only 6 of 104 patients assigned to normothermia(6 percent, P = 0.009). The sutures were removed one day laterin the patients assigned to hypothermia than in those assignedto normothermia (P = 0.002), and the duration of hospitalizationwas prolonged by 2.6 days (approximately 20 percent) in thehypothermia group (P = 0.01).
Conclusions Hypothermia itself may delay healing and predisposepatients to wound infections. Maintaining normothermia intraoperativelyis likely to decrease the incidence of infectious complicationsin patients undergoing colorectal resection and to shorten theirhospitalizations.
Source Information
From the Thermoregulation Research Laboratory and the Department of Anesthesia, University of California, San Francisco (A.K., D.I.S.); and the Departments of Anesthesiology and General Intensive Care, University of Vienna, Vienna, Austria (A.K., D.I.S., R.L.). Presented in part at the International Symposium on the Pharmacology of Thermoregulation, Giessen, Germany, August 17–22, 1994, and at the Annual Meeting of the American Society of Anesthesiologists, Atlanta, October 21–25, 1995.
Address reprint requests to Dr. Sessler at the Department of Anesthesia, 374 Parnassus Ave., 3rd Fl., University of California, San Francisco, CA 94143-0648.
Perioperative Normothermia and Surgical-Wound Infection
Benzer A., Sparr H. J., Kempen P. M., Osler T., Rogers F., Fletcher D., Schein M., Rucinski J., Wise L., Winfree C. J., Baker K. Z., Connolly E. S., Sessler D. I., Kurz A.
Extract |
Full Text
N Engl J Med 1996;
335:747-750, Sep 5, 1996.
Correspondence
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