Perioperative hypothermia in robotic-assisted thoracic surgery: Incidence, risk factors, and associations with postoperative outcomes.
Perioperative hypothermia in robotic-assisted thoracic surgery: Incidence, risk factors, and associations with postoperative outcomes.
复制标题
机器人辅助胸外科手术围手术期低温：发生率、危险因素以及与术后结果的关联。
DOI：
10.1016/j.jtcvs.2023.10.031
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Meguid,RobertA
中科院分区：
文献类型：
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作者：
Stuart,ChristinaM;Dyas,AdamR;Bronsert,MichaelR;Abrams,BenjaminA;Kelleher,AlysonD;Colborn,KathrynL;Randhawa,SimranK;David,ElizabethA;Mitchell,JohnD;Meguid,RobertA
目的不经意的围手术期体温过低与手术效果不佳有关。本研究的目的是评估在2021年1月1日至2022年11月30日期间所有连续接受机器人开胸手术肺切除的患者中，意外低温的发生率和相关的术后并发症。分别于术前单位、麻醉诱导、诱导后30分钟、拔管、到达恢复室5个时间点测量体温。计算每个时间间隔的温度变化。结果313例患者中，肺叶切除201例(64.2%)，肺叶切除50例(16.0%)，楔形切除62例(19.8%)。在所有患者中，291例(93.0%)体温低于36℃，195例(62.3%)体温低于35.5℃，100例(31.9%)体温低于35.0℃。患者在所有时间段都经历了显著的体温变化(P<；1.001)，其中最大的损失发生在术前间隔(离开术前病房到麻醉诱导之间)。经校正分析，围手术期体温低于35.5℃的患者年龄较大(优势比为1.03；95%可信区间为1.01-1.05)，体重指数较低(优势比为0.95；95%可信区间为0.87-0.98)，手术时间延长(优势比为1.00；95%可信区间为1.00-1.01)。围术期体温过低的患者总体发病率和术后感染性并发症的风险调整率较高。结论大多数接受机器人辅助开胸手术的患者围手术期有不同程度的体温过低，并伴随着30d发病率的增加。应实施有组织的、特定间隔的干预措施，以降低意外围术期体温过低和后续并发症的发生率。
ObjectiveInadvertent perioperative hypothermia has been associated with poor surgical outcomes. The purpose of this study was to evaluate the incidence and associated postoperative complications of inadvertent perioperative hypothermia in patients undergoing robotic-assisted thoracic surgery lung resections.MethodsThis was a single-center, retrospective cohort study evaluating all consecutive patients who underwent robotic-assisted thoracic surgery lung resection between January 1, 2021, and November 30, 2022. Temperatures were measured at 5 time points: preprocedure unit, anesthesia induction, 30 minutes postinduction, extubation, and recovery room arrival. Temperature changes were calculated at each interval. Adjusted and unadjusted comparison was performed between those who experienced varying levels of inadvertent perioperative hypothermia (Hypothermia I: <36 °C, Hypothermia II: <35.5 °C, and Hypothermia III: <35 °C) and those who did not.ResultsA total of 313 patients were included, and 201 (64.2%) lobectomies, 50 (16.0%) segmentectomies, and 62 (19.8%) wedge resections were performed. Across all patients, 291 (93.0%) had a temperature less than 36 °C, 195 (62.3%) had a temperature less than 35.5 °C, and 100 (31.9%) had a temperature less than 35.0 °C. Patients experienced significant temperature change at all intervals (P< .001), with the greatest loss occurring during the preprocedure interval (between leaving preprocedure unit and anesthesia induction). On adjusted analysis, patients who experienced inadvertent perioperative hypothermia less than 35.5 °C were older (odds ratio, 1.03; 95% CI, 1.01-1.05), had lower body mass index (odds ratio, 0.95; 95% CI, 0.87-0.98), and had increasing operative time (odds ratio, 1.00; 95% CI, 1.00-1.01). Patients who experienced inadvertent perioperative hypothermia had higher risk-adjusted rates of overall morbidity and infectious postoperative complications.ConclusionsThe majority of patients undergoing robotic-assisted thoracic surgery lung resections experience some degree of inadvertent perioperative hypothermia and have associated increased rates of 30-day morbidity. Structured and interval-specific interventions should be implemented to decrease rates of inadvertent perioperative hypothermia and subsequent complications.