Correlation Between Intraoperative Hypothermia and Perioperative Morbidity in Patients With Head and Neck Cancer | Head and Neck Cancer | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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1.
Singh  BCordeiro  PGSantamaria  EShaha  ARPfister  DGShah  JP Factors associated with complications in microvascular reconstruction of head and neck defects.  Plast Reconstr Surg 1999;103 (2) 403- 411PubMedGoogle ScholarCrossref
2.
Clark  JRMcCluskey  SAHall  F  et al.  Predictors of morbidity following free flap reconstruction for cancer of the head and neck.  Head Neck 2007;29 (12) 1090- 1101PubMedGoogle ScholarCrossref
3.
Mahoney  CBOdom  J Maintaining intraoperative normothermia: a meta-analysis of outcomes with costs.  AANA J 1999;67 (2) 155- 163PubMedGoogle Scholar
4.
Frank  SMBeattie  CChristopherson  R  et al.  Epidural versus general anesthesia, ambient operating room temperature, and patient age as predictors of inadvertent hypothermia.  Anesthesiology 1992;77 (2) 252- 257PubMedGoogle ScholarCrossref
5.
Matsukawa  TKurz  ASessler  DIBjorksten  ARMerrifield  BCheng  C Propofol linearly reduces the vasoconstriction and shivering thresholds.  Anesthesiology 1995;82 (5) 1169- 1180PubMedGoogle ScholarCrossref
6.
Xiong  JKurz  ASessler  DI  et al.  Isoflurane produces marked and nonlinear decreases in the vasoconstriction and shivering thresholds.  Anesthesiology 1996;85 (2) 240- 245PubMedGoogle ScholarCrossref
7.
Annadata  RSessler  DITayefeh  FKurz  ADechert  M Desflurane slightly increases the sweating threshold but produces marked, nonlinear decreases in the vasoconstriction and shivering thresholds.  Anesthesiology 1995;83 (6) 1205- 1211PubMedGoogle ScholarCrossref
8.
Kurz  ASessler  DILenhardt  RStudy of Wound Infection and Temperature Group, Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization.  N Engl J Med 1996;334 (19) 1209- 1215PubMedGoogle ScholarCrossref
9.
Frank  SMFleisher  LABreslow  MJ  et al.  Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: a randomized clinical trial.  JAMA 1997;277 (14) 1127- 1134PubMedGoogle ScholarCrossref
10.
Schmied  HKurz  ASessler  DIKozek  SReiter  A Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty.  Lancet 1996;347 (8997) 289- 292PubMedGoogle ScholarCrossref
11.
Lenhardt  RMarker  EGoll  V  et al.  Mild intraoperative hypothermia prolongs postanesthetic recovery.  Anesthesiology 1997;87 (6) 1318- 1323PubMedGoogle ScholarCrossref
12.
Slotman  GJJed  EHBurchard  KW Adverse effects of hypothermia in postoperative patients.  Am J Surg 1985;149 (4) 495- 501PubMedGoogle ScholarCrossref
13.
Lee  LILin  CCChen  MCLin  CHShyr  MH Anesthesia duration and hypothermia affect graft survival in vascularized free flap surgery.  Tzu Chi Med J 2005;17 (1) 17- 20Google Scholar
14.
Agrawal  NSewell  DAGriswold  MEFrank  SMHessel  TWEisele  DW Hypothermia during head and neck surgery.  Laryngoscope 2003;113 (8) 1278- 1282PubMedGoogle ScholarCrossref
15.
Steinbrook  RASeigne  PW Total-body oxygen consumption after isoflurane anesthesia: effects of mild hypothermia and combined epidural-general anesthesia.  J Clin Anesth 1997;9 (7) 559- 563PubMedGoogle ScholarCrossref
16.
Beilin  BShavit  YRazumovsky  JWolloch  YZeidel  ABessler  H Effects of mild perioperative hypothermia on cellular immune responses.  Anesthesiology 1998;89 (5) 1133- 1140PubMedGoogle ScholarCrossref
17.
Rajagopalan  SMascha  ENa  JSessler  DI The effects of mild perioperative hypothermia on blood loss and transfusion requirement.  Anesthesiology 2008;108 (1) 71- 77PubMedGoogle ScholarCrossref
18.
Jensen  LSAndersen  AJChristiansen  PM  et al.  Postoperative infection and natural killer cell function following blood transfusion in patients undergoing elective colorectal surgery.  Br J Surg 1992;79 (6) 513- 516PubMedGoogle ScholarCrossref
19.
Jensen  LSAndersen  AJChristiansen  PM  et al.  Blood transfusion increases the risk of surgical infection [in Danish].  Ugeskr Laeger 1993;155 (41) 3263- 3266PubMedGoogle Scholar
20.
Grau  CJohansen  LVHansen  HS  et al.  Salvage laryngectomy and pharyngocutaneous fistulae after primary radiotherapy for head and neck cancer: a national survey from DAHANCA.  Head Neck 2003;25 (9) 711- 716PubMedGoogle ScholarCrossref
21.
Choi  SSchwartz  DLFarwell  DGAustin-Seymour  MFutran  N Radiation therapy does not impact local complication rates after free flap reconstruction for head and neck cancer.  Arch Otolaryngol Head Neck Surg 2004;130 (11) 1308- 1312PubMedGoogle ScholarCrossref
Original Article
July 2009

Correlation Between Intraoperative Hypothermia and Perioperative Morbidity in Patients With Head and Neck Cancer

Author Affiliations

Author Affiliations: Department of Otolaryngology–Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas.

Arch Otolaryngol Head Neck Surg. 2009;135(7):682-686. doi:10.1001/archoto.2009.65
Abstract

Objective  To determine if intraoperative hypothermia correlates with perioperative complications in patients undergoing head and neck surgery with regional or free flap reconstructions.

Design  Retrospective medical chart review.

Setting  Academic tertiary care hospital.

Patients  A sample of 136 patients who underwent ablative surgery for head and neck cancer and subsequently required reconstruction with free tissue or a regional flap in the last 10 years.

Main Outcome Measures  Rate of early (within 3 weeks of surgery) perioperative complications and its correlation with patient hypothermia (core body temperature, <35°C).

Results  There were 43 patients with complications. Two patients died. Complications included 10 partial or total flap losses, 9 hematomas, 8 episodes of pneumonia, 7 fistulas, 7 wound infections, 5 wound breakdowns, and 2 cerebrospinal fluid leaks. Factors that did not correlate with complications included having received prior chemotherapy (P = .84), having stage IV cancer (P = .16), sex (P = .43), tobacco use (P = .58), prior radiotherapy (P = .30), the presence of comorbidities (P = .43), age (P = .27), length of surgery (P = .63), and the use of blood products perioperatively (P = .73). Patients who were hypothermic had a significantly higher rate of complications that normothermic patients (P = .002). Stepwise logistic regression analysis identified intraoperative hypothermia as a significant independent predictor for the development of early perioperative complications (odds ratio, 5.122; 95% confidence interval, 1.317-19.917).

Conclusions  Intraoperative hypothermia in head and neck surgery is correlated with perioperative complications. Maintaining normothermia through aggressive warming may decrease the incidence of perioperative morbidity for these patients.

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