Association Between Normothermia at the End of Surgery and Postoperative Complications Following Orthopedic Surgery

Koji Yamada, Koji Nakajima, Hideki Nakamoto, Kazuhiro Kohata, Tomohiro Shinozaki, Hiroyuki Oka, Kiyofumi Yamakawa, Takuya Matsumoto, Fumiaki Tokimura, Hiroyuki Kanai, Yujiro Takeshita, Tatsuro Karita, Yasuhito Tajiri, Hiroshi Okazaki, Sakae Tanaka

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)474-482
Number of pages9
JournalClinical infectious diseases : an official publication of the Infectious Diseases Society of America
Volume70
Issue number3
DOIs
Publication statusPublished - 16 Jan 2020

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Orthopedics
Surgical Wound Infection
Confidence Intervals
Odds Ratio
Mortality
Urinary Tract Infections
Respiratory Tract Infections
Hypothermia
Body Temperature
Ambulatory Surgical Procedures
Tertiary Care Centers
Regression Analysis
Guidelines
Physicians

Keywords

  • mortality
  • normothermia
  • orthopedic surgery
  • surgical site infection

Cite this

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. / Association Between Normothermia at the End of Surgery and Postoperative Complications Following Orthopedic Surgery. In: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2020 ; Vol. 70, No. 3. pp. 474-482.
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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.",
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Yamada, K, Nakajima, K, Nakamoto, H, Kohata, K, Shinozaki, T, Oka, H, Yamakawa, K, Matsumoto, T, Tokimura, F, Kanai, H, Takeshita, Y, Karita, T, Tajiri, Y, Okazaki, H & Tanaka, S 2020, 'Association Between Normothermia at the End of Surgery and Postoperative Complications Following Orthopedic Surgery', Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, vol. 70, no. 3, pp. 474-482. https://doi.org/10.1093/cid/ciz213

Association Between Normothermia at the End of Surgery and Postoperative Complications Following Orthopedic Surgery. / 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.

In: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Vol. 70, No. 3, 16.01.2020, p. 474-482.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Association Between Normothermia at the End of Surgery and Postoperative Complications Following Orthopedic Surgery

AU - Yamada, Koji

AU - Nakajima, Koji

AU - Nakamoto, Hideki

AU - Kohata, Kazuhiro

AU - Shinozaki, Tomohiro

AU - Oka, Hiroyuki

AU - Yamakawa, Kiyofumi

AU - Matsumoto, Takuya

AU - Tokimura, Fumiaki

AU - Kanai, Hiroyuki

AU - Takeshita, Yujiro

AU - Karita, Tatsuro

AU - Tajiri, Yasuhito

AU - Okazaki, Hiroshi

AU - Tanaka, Sakae

PY - 2020/1/16

Y1 - 2020/1/16

N2 - 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.

AB - 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.

KW - mortality

KW - normothermia

KW - orthopedic surgery

KW - surgical site infection

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U2 - 10.1093/cid/ciz213

DO - 10.1093/cid/ciz213

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