A retrospective analysis on the relationship between intraoperative hypothermia and postoperative ileus after laparoscopic colorectal surgery.
A retrospective analysis on the relationship between intraoperative hypothermia and postoperative ileus after laparoscopic colorectal surgery.
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DOI：
10.1371/journal.pone.0190711
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发表时间：
2018
期刊：
影响因子：
3.7
通讯作者：
Kim JY
中科院分区：
文献类型：
--
作者：
Choi JW;Kim DK;Kim JK;Lee EJ;Kim JY
术后肠梗阻（POI）是延长结直肠术后住院时间的重要因素。我们回顾性地探讨了2016年4月至2017年1月期间，我院在加强术后恢复（ERAS）计划下接受腹腔镜结直肠癌手术的恶性肿瘤患者术中低温与POI之间是否存在临床相关的关联。共分析637例患者，其中122例（19.2%）发展为临床和放射学诊断的POI。总体而言，530例（83.2%）患者出现术中低温。虽然POI患者的平均最低核心温度低于无POI患者（35.3±0.5°C vs 35.5±0.5°C, P = 0.004），但基于多因素logistic回归分析未证实术中低温的独立性。除年龄校正Charlson合病指数评分高、手术持续时间长、术后前3天最大疼痛评分高这3个变量外，术后前3天抢救用阿片类药物累积剂量被确定为POI的独立危险因素（每增加1-吗啡当量[mg]，比值比= 1.027,95%可信区间= 1.014-1.040,P <0.001）。体温过低的患者在向软性饮食发展和出院方面均表现出明显的延迟。综上所述，术中低温与ERAS通路中的POI并不是独立相关的，其中除热措施外的其他项目可能抵消其对POI的负面影响。然而，由于它与延迟出院有关，术中仍需要维持正常体温。
Postoperative ileus (POI) is an important factor prolonging the length of hospital stay following colorectal surgery. We retrospectively explored whether there is a clinically relevant association between intraoperative hypothermia and POI in patients who underwent laparoscopic colorectal surgery for malignancy within the setting of an enhanced recovery after surgery (ERAS) program between April 2016 and January 2017 at our institution. In total, 637 patients were analyzed, of whom 122 (19.2%) developed clinically and radiologically diagnosed POI. Overall, 530 (83.2%) patients experienced intraoperative hypothermia. Although the mean lowest core temperature was lower in patients with POI than those without POI (35.3 ± 0.5°C vs. 35.5 ± 0.5°C, P = 0.004), the independence of intraoperative hypothermia was not confirmed based on multivariate logistic regression analysis. In addition to three variables (high age-adjusted Charlson comorbidity index score, long duration of surgery, high maximum pain score during the first 3 days postoperatively), cumulative dose of rescue opioids used during the first 3 days postoperatively was identified as an independent risk factor of POI (odds ratio = 1.027 for each 1-morphine equivalent [mg] increase, 95% confidence interval = 1.014–1.040, P <0.001). Patients with hypothermia showed significant delays in both progression to a soft diet and discharge from hospital. In conclusion, intraoperative hypothermia was not independently associated with POI within an ERAS pathway, in which items other than thermal measures might offset its negative impact on POI. However, as it was associated with delayed discharge from the hospital, intraoperative maintenance of normothermia is still needed.
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