Background. Unintentional perioperative hypothermia is a risk factor for surgical site infection (SSI) for various surgical procedures, but few data are available regarding its role in SSI related to abdominal hysterectomy. We conducted a study to assess the potential role of hypothermia as a risk factor for abdominal hysterectomy-related SSIs.
Methods. A case-control study included all 37 SSIs related to abdominal hysterectomy procedures performed in 2013 at Yale-New Haven Hospital. 100 randomly selected patients who did not develop SSIs after abdominal hysterectomy in 2013 served as controls. An intraoperative temperature < 36.0 C was defined as hypothermia. Variables recorded included the number of each patient's temperature readings reported in EPIC EMR that were < 36.0 C, age, BMI, presence of diabetes mellitus or cancer, surgical approach (laparoscopic or robotic-assisted vs open) and operative procedure time. Statistical analysis included chi-square tests, Mann-Whitney tests and forward stepwise logistic regression.
Results:. Intraoperative temperature records were available for 35/37 cases and 99/100 controls. There were no significant differences between cases and controls with respect to age, BMI, presence of diabetes mellitus or cancer, or procedure time by univariate analysis. Nineteen (54%) of cases, but only 33(33.3%) of controls had > 50% of intraoperative temperatures < 36.0 C (p = 0.029) The mean number of intraoperative temperatures in the hypothermic range for cases (5.97) was significantly greater than that for controls (4.46) (p = 0.015) Overall, 50 (96%) of 52 patients with > 50% of temperatures < 36.0 C met SCIP-INF-10 criteria for normothermia. A logistic regression model using the single best predictor of SSI (the number of hypothermic temperatures) was significant (p < 0.05). When surgical approach was added to the model, it was still significant (p < 0.05). Therefore, the number of hypothermic temperatures and the surgical approach were the best predictors of SSI.
Conclusion. The results suggest that hypothermia is also a significant risk factor for abdominal hysterectomy-related SSIs, and that continued efforts are needed to minimize hypothermia during abdominal hysterectomy procedures.
Disclosures. J. Boyce, 3M Company: Collaborator, Consultant, Investigator, Scientific Advisor and Speaker's Bureau, Consulting fee, Research grant, Research support and Speaker honorarium; Gojo Industries: Consultant, Investigator and Scientific Advisor, Consulting fee, Research grant and Speaker honorarium; Clorox Company: Consultant, Investigator and Scientific Advisor, Consulting fee, Research grant, Research support and Speaker honorarium