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Invited Commentary
June 2015

Lessons Learned in Intraoperative HypothermiaComing In From the Cold

Author Affiliations
  • 1Department of Surgery, University of California, Irvine, Orange
JAMA Surg. 2015;150(6):575-576. doi:10.1001/jamasurg.2015.114

As a young surgical trainee in the 1980s, I learned quickly from my professors, and more profoundly, from my patients, that severe hypothermia was bad, eliciting a coagulopathy that, while reversible, could also be overwhelming. Hypothermia was otherwise indulged or even ignored, seen as an inevitable consequence of the operating room experience. Then, in the mid- to late 1990s, we learned that hypothermia had other consequences, including a reported increase in surgical site infections (SSIs). A landmark randomized prospective trial of routine care vs additional intraoperative warming by Kurz et al,1 published in the New England Journal of Medicine in 1996, changed the landscape and led to the Surgical Care Improvement Project guidelines.2 It also, as noted by Baucom et al3 in this issue of JAMA Surgery, led the Agency for Healthcare Research and Quality4 and the World Health Organization5 to create their own quality metric for the elimination of hypothermia. Baucom and colleagues set about to determine whether intraoperative hypothermia in patients who undergo segmental colectomy is associated with postoperative SSI and whether a more appropriate definition of hypothermia exists and to examine its effect on 30-day SSIs in patients who undergo elective colectomy. To both questions, the answer was no.

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