Association Between Normothermia at the End of Surgery and Postoperative Complications Following Orthopedic Surgery
Abstract Background Maintaining perioperative normothermia is recommended by recent guidelines for the prevention of surgical site infections (SSIs). However, the majority of supporting data originates outside the field of orthopaedic surgery. Methods The effect of normothermia was explored using th...
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| Veröffentlicht in: | Clinical infectious diseases 2020-01, Vol.70 (3), p.474-482 |
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| creator | Yamada, Koji Nakajima, Koji Nakamoto, Hideki Kohata, Kazuhiro Shinozaki, Tomohiro Oka, Hiroyuki Yamakawa, Kiyofumi Matsumoto, Takuya Tokimura, Fumiaki Kanai, Hiroyuki Takeshita, Yujiro Karita, Tatsuro Tajiri, Yasuhito Okazaki, Hiroshi Tanaka, Sakae |
| description | Abstract
Background
Maintaining perioperative normothermia is recommended by recent guidelines for the prevention of surgical site infections (SSIs). However, the majority of supporting data originates outside the field of orthopaedic surgery.
Methods
The effect of normothermia was explored using the prospectively collected data of consecutive patients who underwent single-site surgery in 7 tertiary referral hospitals between November 2013 and July 2016. SSIs, urinary tract infections (UTIs), respiratory tract infections (RTIs), cardiac and cerebral events (CCE), and all-cause mortality rates within 30 days after surgery were compared between patients with normothermia (body temperature ≥36°C) and those with hypothermia ( |
| doi_str_mv | 10.1093/cid/ciz213 |
| format | Article |
| fullrecord | <record><control><sourceid>oup_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1093_cid_ciz213</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/cid/ciz213</oup_id><sourcerecordid>10.1093/cid/ciz213</sourcerecordid><originalsourceid>FETCH-LOGICAL-c383t-18ea3ff339421d4c7f3c56aa984d302e60e95d8409f1eb3f15ad923f15996ac13</originalsourceid><addsrcrecordid>eNp9kE9LAzEQxYMotlYvfgDJxYuwmuzsbpNjLa0KxQrqeUnzp43sNkuytdRPb-paj8IM8wZ-7x0eQpeU3FLC4U5aFfcrpXCE-jSHYVLknB5HTXKWZAxYD52F8EEIpYzkp6gHhBUQp4_CKAQnrWitW-N73W61XuNn52vXrrSvrcCixVHiyVphZ_Drxi-132ER3xcXWtdoH82fGo9d3VRW_iQFPHVV5bZ2vcRz364ipaw8mM_RiRFV0Be_d4Dep5O38WMymz88jUezRAKDNqFMCzAGgGcpVZkcGpB5IQRnmQKS6oJoniuWEW6oXoChuVA83V_OCyEpDNBNlyu9C8FrUzbe1sLvSkrKfXNlbK7smovwVQc3m0Wt1R96qCoC1x3gNs1_Qd8To3lM</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Association Between Normothermia at the End of Surgery and Postoperative Complications Following Orthopedic Surgery</title><source>MEDLINE</source><source>Oxford University Press Journals All Titles (1996-Current)</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Yamada, Koji ; Nakajima, Koji ; Nakamoto, Hideki ; Kohata, Kazuhiro ; Shinozaki, Tomohiro ; Oka, Hiroyuki ; Yamakawa, Kiyofumi ; Matsumoto, Takuya ; Tokimura, Fumiaki ; Kanai, Hiroyuki ; Takeshita, Yujiro ; Karita, Tatsuro ; Tajiri, Yasuhito ; Okazaki, Hiroshi ; Tanaka, Sakae</creator><creatorcontrib>Yamada, Koji ; Nakajima, Koji ; Nakamoto, Hideki ; Kohata, Kazuhiro ; Shinozaki, Tomohiro ; Oka, Hiroyuki ; Yamakawa, Kiyofumi ; Matsumoto, Takuya ; Tokimura, Fumiaki ; Kanai, Hiroyuki ; Takeshita, Yujiro ; Karita, Tatsuro ; Tajiri, Yasuhito ; Okazaki, Hiroshi ; Tanaka, Sakae</creatorcontrib><description>Abstract
Background
Maintaining perioperative normothermia is recommended by recent guidelines for the prevention of surgical site infections (SSIs). However, the majority of supporting data originates outside the field of orthopaedic surgery.
Methods
The effect of normothermia was explored using the prospectively collected data of consecutive patients who underwent single-site surgery in 7 tertiary referral hospitals between November 2013 and July 2016. SSIs, urinary tract infections (UTIs), respiratory tract infections (RTIs), cardiac and cerebral events (CCE), and all-cause mortality rates within 30 days after surgery were compared between patients with normothermia (body temperature ≥36°C) and those with hypothermia (<36°C) at the end of surgery, after closure. Multivariable adjusted and inverse-probability weighted regression analyses were performed.
Results
The final cohort included 8841 patients. Of these, 11.4% (n = 1008) were hypothermic. More than 96% were evaluated in person by the physicians. After adjusting for multiple covariates, normothermia was not significantly associated with SSIs (adjusted odds ratio [aOR] 1.18, 95% confidence interval [CI] 0.59–2.33), UTIs (aOR 1.14, 95% CI 0.66–1.95), RTIs (aOR 0.60, 95% CI 0.31–1.19), or CCE (aOR 0.53, 95% CI 0.26–1.09). In contrast, normothermia was associated with a lower risk of 30-day mortality (aOR 0.26, 95% CI 0.11–0.64; P < .01; weighted hazard ratio 0.21, 95% CI 0.07–0.68; P = .002). In a subgroup analysis, normothermia was associated with reduced mortality in all types of surgical procedures.
Conclusions
Whereas our findings suggest no clear association with SSI risks following orthopedic surgery, our study supports maintaining perioperative normothermia, as it is associated with reduced 30-day mortality.
In 8841 clean orthopedic surgeries, normothermia was not associated with surgical site, urinary tract, or respiratory tract infections or with cardiac and cerebral events. In contrast, normothermia was associated with a lower risk for 30-day mortality (weighted hazard ratio 0.21).</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1093/cid/ciz213</identifier><identifier>PMID: 30863863</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Body Temperature ; Cohort Studies ; Humans ; Hypothermia - epidemiology ; Orthopedic Procedures - adverse effects ; Postoperative Complications - epidemiology ; Surgical Wound Infection - epidemiology</subject><ispartof>Clinical infectious diseases, 2020-01, Vol.70 (3), p.474-482</ispartof><rights>The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com. 2019</rights><rights>The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c383t-18ea3ff339421d4c7f3c56aa984d302e60e95d8409f1eb3f15ad923f15996ac13</citedby><cites>FETCH-LOGICAL-c383t-18ea3ff339421d4c7f3c56aa984d302e60e95d8409f1eb3f15ad923f15996ac13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,1584,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30863863$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Yamada, Koji</creatorcontrib><creatorcontrib>Nakajima, Koji</creatorcontrib><creatorcontrib>Nakamoto, Hideki</creatorcontrib><creatorcontrib>Kohata, Kazuhiro</creatorcontrib><creatorcontrib>Shinozaki, Tomohiro</creatorcontrib><creatorcontrib>Oka, Hiroyuki</creatorcontrib><creatorcontrib>Yamakawa, Kiyofumi</creatorcontrib><creatorcontrib>Matsumoto, Takuya</creatorcontrib><creatorcontrib>Tokimura, Fumiaki</creatorcontrib><creatorcontrib>Kanai, Hiroyuki</creatorcontrib><creatorcontrib>Takeshita, Yujiro</creatorcontrib><creatorcontrib>Karita, Tatsuro</creatorcontrib><creatorcontrib>Tajiri, Yasuhito</creatorcontrib><creatorcontrib>Okazaki, Hiroshi</creatorcontrib><creatorcontrib>Tanaka, Sakae</creatorcontrib><title>Association Between Normothermia at the End of Surgery and Postoperative Complications Following Orthopedic Surgery</title><title>Clinical infectious diseases</title><addtitle>Clin Infect Dis</addtitle><description>Abstract
Background
Maintaining perioperative normothermia is recommended by recent guidelines for the prevention of surgical site infections (SSIs). However, the majority of supporting data originates outside the field of orthopaedic surgery.
Methods
The effect of normothermia was explored using the prospectively collected data of consecutive patients who underwent single-site surgery in 7 tertiary referral hospitals between November 2013 and July 2016. SSIs, urinary tract infections (UTIs), respiratory tract infections (RTIs), cardiac and cerebral events (CCE), and all-cause mortality rates within 30 days after surgery were compared between patients with normothermia (body temperature ≥36°C) and those with hypothermia (<36°C) at the end of surgery, after closure. Multivariable adjusted and inverse-probability weighted regression analyses were performed.
Results
The final cohort included 8841 patients. Of these, 11.4% (n = 1008) were hypothermic. More than 96% were evaluated in person by the physicians. After adjusting for multiple covariates, normothermia was not significantly associated with SSIs (adjusted odds ratio [aOR] 1.18, 95% confidence interval [CI] 0.59–2.33), UTIs (aOR 1.14, 95% CI 0.66–1.95), RTIs (aOR 0.60, 95% CI 0.31–1.19), or CCE (aOR 0.53, 95% CI 0.26–1.09). In contrast, normothermia was associated with a lower risk of 30-day mortality (aOR 0.26, 95% CI 0.11–0.64; P < .01; weighted hazard ratio 0.21, 95% CI 0.07–0.68; P = .002). In a subgroup analysis, normothermia was associated with reduced mortality in all types of surgical procedures.
Conclusions
Whereas our findings suggest no clear association with SSI risks following orthopedic surgery, our study supports maintaining perioperative normothermia, as it is associated with reduced 30-day mortality.
In 8841 clean orthopedic surgeries, normothermia was not associated with surgical site, urinary tract, or respiratory tract infections or with cardiac and cerebral events. In contrast, normothermia was associated with a lower risk for 30-day mortality (weighted hazard ratio 0.21).</description><subject>Body Temperature</subject><subject>Cohort Studies</subject><subject>Humans</subject><subject>Hypothermia - epidemiology</subject><subject>Orthopedic Procedures - adverse effects</subject><subject>Postoperative Complications - epidemiology</subject><subject>Surgical Wound Infection - epidemiology</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kE9LAzEQxYMotlYvfgDJxYuwmuzsbpNjLa0KxQrqeUnzp43sNkuytdRPb-paj8IM8wZ-7x0eQpeU3FLC4U5aFfcrpXCE-jSHYVLknB5HTXKWZAxYD52F8EEIpYzkp6gHhBUQp4_CKAQnrWitW-N73W61XuNn52vXrrSvrcCixVHiyVphZ_Drxi-132ER3xcXWtdoH82fGo9d3VRW_iQFPHVV5bZ2vcRz364ipaw8mM_RiRFV0Be_d4Dep5O38WMymz88jUezRAKDNqFMCzAGgGcpVZkcGpB5IQRnmQKS6oJoniuWEW6oXoChuVA83V_OCyEpDNBNlyu9C8FrUzbe1sLvSkrKfXNlbK7smovwVQc3m0Wt1R96qCoC1x3gNs1_Qd8To3lM</recordid><startdate>20200116</startdate><enddate>20200116</enddate><creator>Yamada, Koji</creator><creator>Nakajima, Koji</creator><creator>Nakamoto, Hideki</creator><creator>Kohata, Kazuhiro</creator><creator>Shinozaki, Tomohiro</creator><creator>Oka, Hiroyuki</creator><creator>Yamakawa, Kiyofumi</creator><creator>Matsumoto, Takuya</creator><creator>Tokimura, Fumiaki</creator><creator>Kanai, Hiroyuki</creator><creator>Takeshita, Yujiro</creator><creator>Karita, Tatsuro</creator><creator>Tajiri, Yasuhito</creator><creator>Okazaki, Hiroshi</creator><creator>Tanaka, Sakae</creator><general>Oxford University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20200116</creationdate><title>Association Between Normothermia at the End of Surgery and Postoperative Complications Following Orthopedic Surgery</title><author>Yamada, Koji ; Nakajima, Koji ; Nakamoto, Hideki ; Kohata, Kazuhiro ; Shinozaki, Tomohiro ; Oka, Hiroyuki ; Yamakawa, Kiyofumi ; Matsumoto, Takuya ; Tokimura, Fumiaki ; Kanai, Hiroyuki ; Takeshita, Yujiro ; Karita, Tatsuro ; Tajiri, Yasuhito ; Okazaki, Hiroshi ; Tanaka, Sakae</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c383t-18ea3ff339421d4c7f3c56aa984d302e60e95d8409f1eb3f15ad923f15996ac13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Body Temperature</topic><topic>Cohort Studies</topic><topic>Humans</topic><topic>Hypothermia - epidemiology</topic><topic>Orthopedic Procedures - adverse effects</topic><topic>Postoperative Complications - epidemiology</topic><topic>Surgical Wound Infection - epidemiology</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Yamada, Koji</creatorcontrib><creatorcontrib>Nakajima, Koji</creatorcontrib><creatorcontrib>Nakamoto, Hideki</creatorcontrib><creatorcontrib>Kohata, Kazuhiro</creatorcontrib><creatorcontrib>Shinozaki, Tomohiro</creatorcontrib><creatorcontrib>Oka, Hiroyuki</creatorcontrib><creatorcontrib>Yamakawa, Kiyofumi</creatorcontrib><creatorcontrib>Matsumoto, Takuya</creatorcontrib><creatorcontrib>Tokimura, Fumiaki</creatorcontrib><creatorcontrib>Kanai, Hiroyuki</creatorcontrib><creatorcontrib>Takeshita, Yujiro</creatorcontrib><creatorcontrib>Karita, Tatsuro</creatorcontrib><creatorcontrib>Tajiri, Yasuhito</creatorcontrib><creatorcontrib>Okazaki, Hiroshi</creatorcontrib><creatorcontrib>Tanaka, Sakae</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Yamada, Koji</au><au>Nakajima, Koji</au><au>Nakamoto, Hideki</au><au>Kohata, Kazuhiro</au><au>Shinozaki, Tomohiro</au><au>Oka, Hiroyuki</au><au>Yamakawa, Kiyofumi</au><au>Matsumoto, Takuya</au><au>Tokimura, Fumiaki</au><au>Kanai, Hiroyuki</au><au>Takeshita, Yujiro</au><au>Karita, Tatsuro</au><au>Tajiri, Yasuhito</au><au>Okazaki, Hiroshi</au><au>Tanaka, Sakae</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Association Between Normothermia at the End of Surgery and Postoperative Complications Following Orthopedic Surgery</atitle><jtitle>Clinical infectious diseases</jtitle><addtitle>Clin Infect Dis</addtitle><date>2020-01-16</date><risdate>2020</risdate><volume>70</volume><issue>3</issue><spage>474</spage><epage>482</epage><pages>474-482</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><abstract>Abstract
Background
Maintaining perioperative normothermia is recommended by recent guidelines for the prevention of surgical site infections (SSIs). However, the majority of supporting data originates outside the field of orthopaedic surgery.
Methods
The effect of normothermia was explored using the prospectively collected data of consecutive patients who underwent single-site surgery in 7 tertiary referral hospitals between November 2013 and July 2016. SSIs, urinary tract infections (UTIs), respiratory tract infections (RTIs), cardiac and cerebral events (CCE), and all-cause mortality rates within 30 days after surgery were compared between patients with normothermia (body temperature ≥36°C) and those with hypothermia (<36°C) at the end of surgery, after closure. Multivariable adjusted and inverse-probability weighted regression analyses were performed.
Results
The final cohort included 8841 patients. Of these, 11.4% (n = 1008) were hypothermic. More than 96% were evaluated in person by the physicians. After adjusting for multiple covariates, normothermia was not significantly associated with SSIs (adjusted odds ratio [aOR] 1.18, 95% confidence interval [CI] 0.59–2.33), UTIs (aOR 1.14, 95% CI 0.66–1.95), RTIs (aOR 0.60, 95% CI 0.31–1.19), or CCE (aOR 0.53, 95% CI 0.26–1.09). In contrast, normothermia was associated with a lower risk of 30-day mortality (aOR 0.26, 95% CI 0.11–0.64; P < .01; weighted hazard ratio 0.21, 95% CI 0.07–0.68; P = .002). In a subgroup analysis, normothermia was associated with reduced mortality in all types of surgical procedures.
Conclusions
Whereas our findings suggest no clear association with SSI risks following orthopedic surgery, our study supports maintaining perioperative normothermia, as it is associated with reduced 30-day mortality.
In 8841 clean orthopedic surgeries, normothermia was not associated with surgical site, urinary tract, or respiratory tract infections or with cardiac and cerebral events. In contrast, normothermia was associated with a lower risk for 30-day mortality (weighted hazard ratio 0.21).</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>30863863</pmid><doi>10.1093/cid/ciz213</doi><tpages>9</tpages></addata></record> |
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| ispartof | Clinical infectious diseases, 2020-01, Vol.70 (3), p.474-482 |
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| source | MEDLINE; Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Body Temperature Cohort Studies Humans Hypothermia - epidemiology Orthopedic Procedures - adverse effects Postoperative Complications - epidemiology Surgical Wound Infection - epidemiology |
| title | Association Between Normothermia at the End of Surgery and Postoperative Complications Following Orthopedic Surgery |
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