Relation of intraoperative temperature to postoperative mortality in open colon surgery—an analysis of two randomized controlled trials

Abstract

IntroductionThe open surgical wound is exposed to cold and dry ambient air resulting in heat loss mainly through radiation and convection. This cools the wound and promotes local vasoconstriction and hypoxia. Carbon dioxide (CO2) and water vapor are greenhouse gases with a warming effect. The aim was to evaluate if warm humidified CO2 insufflated in surgical wound can affect long-term overall mortalityMethodsThis is a retrospective study of two clinical trials, where patients were randomized to warm humidified CO2 (n = 80) or not (n = 78). All patients underwent elective major open colon surgery. Patients in the treatment group received insufflation of warm humidified CO2 into the open wound cavity via a gas diffuser to create a local atmosphere of 100 % CO2. Temperature in the wound cavity was measured with a heat-sensitive infrared camera. Core temperature was measured at the tympanic membrane. Median follow-up was 70.9 months.ResultsA multivariate analysis adjusted for age (p = 0.001) and cancer (p = 0.165) showed that the larger the temperature difference between final core temperature and wound edge temperature, the lower the overall survival rate (p = 0.050). Patients receiving insufflation of warm humidified CO2 had a tendency to a better overall survival compared with control patients (p = 0.508). End-of-operation wound edge temperature was negatively associated with mortality (OR = 0.80, 95 % CI = 0.68-0.95, p = 0.011), whereas mortality was positively associated with age (10-year increase, OR = 1.78, 95 % CI = 1.37-2.33, p < 0.001) and cancer (OR = 8.1, 95 % CI = 1.95–33.7, p = 0.004).ConclusionsA small end-of-operation temperature difference between final core and wound edge temperature was positively associated with patient survival in open colon surgery.

Modeling open surgery in mice to explore peritoneal damage, carbon dioxide humidification and desmoidogenesis

“…In an attempt to address and to minimize open surgery-associated peritoneal damage, we have explored the use of humidified-warm carbon dioxide (HWCO 2 ) delivered via a bespoke mini gas perfusion device. In this passive airflow model, we reported protection of the peritoneal surfaces by using HWCO 2 [5], similar to that employed in human open surgery [7]. Here, we advanced our investigation of peritoneal damage by engineering a surgery theatre set-up designed for mice whereby airflow was instead delivered by active airflow.…”

Effects of Warmed and Humidified CO2 Surgical Site Insufflation in a Novel Experimental Model of Magnetic Compression Colonic Anastomosis

“…9 Our hypothesis was that WH-CO 2 , besides preventing the occurrence of intraoperative hypothermia, will also increase local bowel perfusion and reduce the risks of anastomotic leakage. Few studies have assessed the impact of CO 2 insufflation in colorectal surgery 10,11 but none with the specific aim to study the effects of WH-CO 2 on the healing process of colorectal anastomosis. Our aim was to evaluate the systemic and local impact of WH-CO 2 laminar insufflation in a survival rodent model of magnetic compression colonic anastomosis.…”

Is there a role for warm humidified carbon dioxide insufflation in open abdominal surgery?

“…When this technique was utilized, peritoneal biopsies revealed a reduction in oxidative damage and apoptosis of cells, and maintenance of cell structure on microscopy 5,20 . Few studies also measured postoperative outcomes such as surgical site infections, anastomotic leak, length of stay, and mortality, although no statistically significant differences were seen 5,17–20 . A recent randomized controlled trial revealed a reduction in surgical site infections from 13% in conventional open surgery to 4.5% in the warm humidified group, and although this was in accordance with laparoscopic studies (5.7% versus 13%), this result was not statistically significant ( P = 0.092) 19,21 …”

“…In concordance with its use in laparoscopic surgery, studies where warm humidification is used in open surgery also show promising results for maintaining intraoperative normothermia and minimizing peritoneal damage. In these studies, patients who received warm humidification had a greater average mean core temperature, end of surgery core temperature, and were less likely to become hypothermic at any time during the operation 17–19 . When this technique was utilized, peritoneal biopsies revealed a reduction in oxidative damage and apoptosis of cells, and maintenance of cell structure on microscopy 5,20 .…”

“…In these studies, patients who received warm humidification had a greater average mean core temperature, end of surgery core temperature, and were less likely to become hypothermic at any time during the operation. [17][18][19] When this technique was utilized, peritoneal biopsies revealed a reduction in oxidative damage and apoptosis of cells, and maintenance of cell structure on microscopy. 5,20 Few studies also measured postoperative outcomes such as surgical site infections, anastomotic leak, length of stay, and mortality, although no statistically significant differences were seen.…”