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Perioperative Hypothermia in Elderly Patients During Pelvic Floor Reconstruction Surgery: An Observational Study

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Abstract

Introduction and Hypothesis

The potential predictors of pelvic floor reconstruction surgery hypothermia remain unclear. This prospective cohort study was aimed at identifying these predictors and evaluating the outcomes associated with perioperative hypothermia.

Methods

Elderly patients undergoing pelvic floor reconstruction surgery were consecutively enrolled from April 2023 to September 2023. Perioperative temperature was measured at preoperative (T1), every 15 min after the start of anesthesia (T2), and 15 min postoperative (T3) using a temperature probe. Perioperative hypothermia was defined as a core temperature below 36°C at any point during the procedure. Multivariate logistic regression analysis was conducted to determine factors associated with perioperative hypothermia.

Results

A total of 229 patients were included in the study, with 50.7% experiencing hypothermia. Multivariate analysis revealed that the surgical method involving pelvic floor combined with laparoscopy, preoperative temperature < 36.5°C, anesthesia duration ≥ 120 min, and the high levels of anxiety were significantly associated with perioperative hypothermia. The predictive value of the multivariate model was 0.767 (95% CI, 0.706 to 0.828).

Conclusions

This observational prospective study identified several predictive factors for perioperative hypothermia in elderly patients during pelvic floor reconstruction surgery. Strategies aimed at preventing perioperative hypothermia should target these factors. Further studies are required to assess the effectiveness of these strategies, specifically in elderly patients undergoing pelvic floor reconstruction surgery.

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Data Availability

The datasets used during the current study are available from the corresponding author on reasonable request.

Abbreviations

ASA:

American Standards Association

BMI:

Body mass index

LOS:

Length of hospital stay

PFD:

Pelvic floor dysfunction

PONV:

Postoperative nausea and vomiting

SAS:

Self-rating Anxiety Scale

References

  1. Wilkins MF, Wu JM. Lifetime risk of surgery for stress urinary incontinence or pelvic organ prolapse. Minerva Ginecol. 2017;69(2):171–7.

    PubMed  Google Scholar 

  2. Abdel-Fattah M, Familusi A, Fielding S, Ford J, Bhattacharya S. Primary and repeat surgical treatment for female pelvic organ prolapse and incontinence in parous women in the UK: a register linkage study. BMJ Open. 2011;1(2):e000206.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Torossian A, Bräuer A, Höcker J, Bein B, Wulf H, Horn EP. Preventing inadvertent perioperative hypothermia. Dtsch Arztebl Int. 2015;112(10):166–72.

    PubMed  PubMed Central  Google Scholar 

  4. Frisch NB, Pepper AM, Rooney E, Silverton C. Intraoperative hypothermia in total hip and knee arthroplasty. Orthopedics. 2017;40(1):56–63.

    Article  PubMed  Google Scholar 

  5. Ryczek E, White J, Poole RL, Reeves NL, Torkington J, Carolan-Rees G. Normothermic insufflation to prevent perioperative hypothermia and improve quality of recovery in elective colectomy patients: protocol for a randomized controlled trial. JMIR Res Protoc. 2019;8(12):e14533.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Billeter AT, Hohmann SF, Druen D, Cannon R, Polk HC Jr. Unintentional perioperative hypothermia is associated with severe complications and high mortality in elective operations. Surgery. 2014;156(5):1245–52.

    Article  PubMed  Google Scholar 

  7. Melling AC, Ali B, Scott EM, Leaper DJ. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial. Lancet. 2001;358(9285):876–80.

    Article  CAS  PubMed  Google Scholar 

  8. Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA. 1997;277(14):1127–34.

    Article  CAS  PubMed  Google Scholar 

  9. Rajagopalan S, Mascha E, Na J, Sessler DI. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology. 2008;108(1):71–7.

    Article  PubMed  Google Scholar 

  10. Bock M, Müller J, Bach A, Böhrer H, Martin E, Motsch J. Effects of preinduction and intraoperative warming during major laparotomy. Br J Anaesth. 1998;80(2):159–63.

    Article  CAS  PubMed  Google Scholar 

  11. Grassi G, Seravalle G, Turri C, Bertinieri G, Dell’Oro R, Mancia G. Impairment of thermoregulatory control of skin sympathetic nerve traffic in the elderly. Circulation. 2003;108(6):729–35.

    Article  PubMed  Google Scholar 

  12. Vandenbroucke JP, von Elm E, Altman DG, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Ann Intern Med. 2007;147(8):W163–94.

    Article  PubMed  Google Scholar 

  13. Zung WW. A rating instrument for anxiety disorders. Psychosomatics. 1971;12(6):371–9.

    Article  CAS  PubMed  Google Scholar 

  14. Desgranges FP, Bapteste L, Riffard C, et al. Predictive factors of maternal hypothermia during Cesarean delivery: a prospective cohort study. Can J Anaesth. 2017;64(9):919–27.

    Article  PubMed  Google Scholar 

  15. Sultan P, Habib AS, Cho Y, Carvalho B. The effect of patient warming during caesarean delivery on maternal and neonatal outcomes: a meta-analysis. Br J Anaesth. 2015;115(4):500–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Kim EJ, Yoon H. Preoperative factors affecting the intraoperative core body temperature in abdominal surgery under general anesthesia: an observational cohort. Clin Nurse Spec. 2014;28(5):268–76.

    Article  PubMed  Google Scholar 

  17. Long KC, Tanner EJ, Frey M, et al. Intraoperative hypothermia during primary surgical cytoreduction for advanced ovarian cancer: risk factors and associations with postoperative morbidity. Gynecol Oncol. 2013;131(3):525–30.

    Article  PubMed  Google Scholar 

  18. Horn EP, Bein B, Broch O, et al. Warming before and after epidural block before general anaesthesia for major abdominal surgery prevents perioperative hypothermia: a randomised controlled trial. Eur J Anaesthesiol. 2016;33(5):334–40.

    Article  CAS  PubMed  Google Scholar 

  19. Scott AV, Stonemetz JL, Wasey JO, et al. Compliance with Surgical Care Improvement Project for body temperature management (SCIP Inf-10) is associated with improved clinical outcomes. Anesthesiology. 2015;123(1):116–25.

    Article  PubMed  Google Scholar 

  20. Yi J, **ang Z, Deng X, et al. Incidence of inadvertent intraoperative hypothermia and its risk factors in patients undergoing general anesthesia in Bei**g: a prospective regional survey. PLoS One. 2015;10(9):e0136136.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Matsukawa T, Kurz A, Sessler DI, Bjorksten AR, Merrifield B, Cheng C. Propofol linearly reduces the vasoconstriction and shivering thresholds. Anesthesiology. 1995;82(5):1169–80.

    Article  CAS  PubMed  Google Scholar 

  22. De Witte JL, Kim JS, Sessler DI, Bastanmehr H, Bjorksten AR. Tramadol reduces the sweating, vasoconstriction, and shivering thresholds. Anesth Analg. 1998;87(1):173–9.

    Article  PubMed  Google Scholar 

  23. Torossian A, Bein B, Bräuer A, et al. Leitlinie “Vermeidung von perioperativer Hypothermie”—Aktualisierung. 2019. Available online: https://www.awmf.org/awmf-online-das-portal-der-wissenschaftlichen-medizin/awmf-aktuell.html. Accessed on 1 July 2021.

  24. Tekgul ZT, Pektas S, Yildirim U, et al. A prospective randomized double-blind study on the effects of the temperature of irrigation solutions on thermoregulation and postoperative complications in percutaneous nephrolithotomy. J Anesth. 2015;29(2):165–9.

    Article  PubMed  Google Scholar 

  25. Fischer S, Haas F, Strahler J. A systematic review of thermosensation and thermoregulation in anxiety disorders. Front Physiol. 2021;12:784943.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Lopez MB. Postanaesthetic shivering—from pathophysiology to prevention. Rom J Anaesth Intensive Care. 2018;25(1):73–81.

    PubMed  PubMed Central  Google Scholar 

  27. Jun JH, Chung MH, Jun IJ, et al. Efficacy of forced-air warming and warmed intravenous fluid for prevention of hypothermia and shivering during caesarean delivery under spinal anaesthesia: a randomised controlled trial. Eur J Anaesthesiol. 2019;36(6):442–8.

    Article  PubMed  Google Scholar 

  28. Sessler DI. Perioperative thermoregulation and heat balance. Lancet. 2016;387(10038):2655–64.

    Article  PubMed  Google Scholar 

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Funding

No funding was received.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Hangzhou Women’s Hospital (Hangzhou Maternity and Child Health Care Hospital), Hangzhou, 310008, China

    Yang Jiang, Zhen-feng Zhou, Ri-zhi Shao, **ao-fei Qiu & **ao-yan Li

  2. Department of Urolithiasis and Anorectal Surgery, Ningbo No. 2 Hospital, 41 **bei Street, Ningbo, 315010, Zhejiang Province, China

    Chun-cong Zhou

Authors
  1. Yang Jiang
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  2. Zhen-feng Zhou
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  3. Ri-zhi Shao
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  4. **ao-fei Qiu
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  5. **ao-yan Li
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Contributions

C.-C.Z and Y.J.: study design and writing the paper; X.-F.-Q. performed the statistical analysis; Z.-F.Z. assisted with the English polishing and editing process of the article; R.-Z.S. and X.-Y.L.: patient recruitment and data collection. All authors have read the manuscript and approved the final paper submitted.

Corresponding author

Correspondence to Chun-cong Zhou.

Ethics declarations

Ethics Statement

This single-center, prospective observational study was conducted from 28 April 2023 to 28 September 2023, with approval from the Ethics Committee of Hangzhou Women's Hospital (IRB: 202203–10).

Copyright Transfer Statement

The copyright to this article is transferred to the International Urogynecology Journal when the article is accepted for publication. The copyright transfer covers the exclusive right to reproduce and distribute the article, including reprints, translations, photographic reproductions, microform, electronic form (offline, online) or any other reproductions of a similar nature.

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Not applicable.

Conflicts of Interest

None.

Additional information

Handling Editor: Holly E. Richter

Editor in Chief: Maria A. Bortolini

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Trial number and registry URL: ChiCTR2300070782;  http://www.chictr.org.cn , Principal investigator: Jiang; date of registration: 28 April 2023

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Supplemental Appendix 2 (DOC 42 KB)

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Jiang, Y., Zhou, Zf., Shao, Rz. et al. Perioperative Hypothermia in Elderly Patients During Pelvic Floor Reconstruction Surgery: An Observational Study. Int Urogynecol J (2024). https://doi.org/10.1007/s00192-024-05781-9

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