Incidence of Severe Hypothermia and Its Impact on Postoperative Surgical Complications and Time Delay to Adjunct Treatments in Breast Surgery Cancer Patients: A Case-Controlled Study

Abstract

Introduction: Unintended postoperative hypothermia frequently occurs upon arrival in the post anesthesia care unit (PACU). As part of our quality assurance program in anesthesia, we regularly monitor the incidence of this complication through our anesthesia information management system (AIMS). In this case-controlled retrospective study, our goal was to detect the incidence of unintended severe hypothermia in our breast surgery cancer patients, and subsequently to analyze the consequence of this complication in terms postoperative cutaneous infection, as well as its impact on further complementary treatment, such as radiotherapy and chemotherapy. Methods: This study was a retrospective analysis conducted through our AIMS system from 2015 through 2019, with extraction criteria based on year, type of surgery (breast), and temperature upon arrival in PACU. A tympanic temperature of less than 36 °C was considered to indicate hypothermia. Severe hypothermia was considered for patients having a temperature lower than 35.2 °C (hypothermic) (n = 80), who were paired using a propensity score analysis with a control group (normothermic) (n = 80) of other breast cancer surgery patients. Extracted data included time of surgery, sex, age, ASA status, and type and duration of the intervention. Results: The mean incidence of hypothermia was 21% from 2015 through 2019. The body mass index (BMI) was significantly lower in the hypothermia group before matching, 23.5 ± 4.1 vs. 26.4 ± 6.1 kg/m2 in normothermic patients (p < 0.05). The hypothermia group also had significantly fewer monitoring and active warming devices. No difference was noted for wound complications. Time to complementary chemotherapy and or radiotherapy did not differ between groups (52 ± 21 days in group hypothermia vs 49 ± 22 days in the control group). Conclusion: Severe intraoperative hypothermia remains an important quality assurance issue in our breast surgery cancer patients, but we could not detect any long-term effect of hypothermia.

Impact of Intraoperative Hypothermia on Incidence of Infection in Implant-Based Breast Reconstruction

“…In breast cancer surgery, a study conducted by Motamed et al showed no difference in complication/infection, nor did it show a delay to adjuvant radiation therapy or chemotherapy for patients who experienced hypothermia. 28 There are also studies that link the use of ADM and radiation therapy to increased likelihood of SSI in the breast cancer reconstruction patient population; however, in our study, we found no significant difference between the two cohorts with respect to the use of ADM or rates of chemotherapy/radiation therapy, making it unlikely that these variables impacted the results of our study, indicating that hypothermia increased the likelihood of SSI in this population. 9,29 Another potential, anecdotal source of SSI in this patient population is the use of forced-air warmers; however, the literature is conflicting on the use of forced-air warmers and SSI.…”

Bilateral Simultaneous LAP Flaps in Breast Reconstruction: Perioperative anesthetic outcomes addressing safety and feasibility

“…26 In addition, intraoperative hypothermia has been linked to delayed hospital discharge. 27 In this study, we could not establish a statistical correlation between hypothermia and wound complications, such as wound dehiscence or wound infection. Previous experimental and clinical studies have investigated the influence of hypothermia on microvascular complications.…”

Impact of Intraoperative Hypothermia on Autologous Breast Reconstruction

“…When examining the plastic surgery and breast cancer surgery literature, there are multiple studies looking at the effect of hypothermia. In a previous study, patients who experienced perioperative hypothermia in breast cancer surgery did not have any long-term complications with regard to SSI or delay to adjuvant radiation/chemotherapy 37 . In elective plastic surgery, there are conflicting studies with some demonstrating no differences in postoperative outcomes and others finding increased risk of seroma formation, longer recovery times, higher pain scores, and increased usage of opioids 38–41 .…”

“…In a previous study, patients who experienced perioperative hypothermia in breast cancer surgery did not have any long-term complications with regard to SSI or delay to adjuvant radiation/chemotherapy. 37 In elective plastic surgery, there are conflicting studies with some demonstrating no differences in postoperative outcomes and others finding increased risk of seroma formation, longer recovery times, higher pain scores, and increased usage of opioids. [38][39][40][41] While these studies primarily include body contouring patients, they support the findings of this study.…”