Relación entre la presencia de hipotermia en el postoperatorio inmediato y la aparición de complicaciones clínicas en una unidad de reanimación postquirúrgica en pacientes intervenidos de cirugía colorrectal electiva

Abstract

Aim: To evaluate the differences in morbidity, hospital stay clinical complications and mortality of a group of patients undergoing intestinal resection surgery with terminal term anastomosis at the Reina Sofía General University Hospital in Murcia (HGURS), according to the tympanic temperature recorded on arrival at the Resuscitation Unit after surgery. Hypothermia is defined as body temperature below 36ºC. It is classified as mild (33- 36ºC), moderate (30-33ºC) and severe (below 28ºC). It is a relatively frequent problem in patients admitted to a Critical Care Unit after surgery. Impairment of thermoregulation induced by anesthesia, exposure to the cold operating room environment, surgical incision, mechanical ventilation and infusion of cold fluids leads to hypothermia in about half of surgical patients. This hypothermia can be associated with an increase in complications in the immediate postoperative period and during hospitalization, and can be related to increased mortality, increased infection rate, analytical alterations, increased hospital stay, increased surgical bleeding with the need for transfusion, as well as altered level of consciousness during the first 24 hours after surgery. These complications are important and can trigger undesirable effects in the perioperative period, so it is important to be aware of them and take measures to maintain normothermia in patients during surgery and postoperative care. Material and methods: A retrospective observational analytical study has been performed with the analysis of data from the medical records of patients undergoing bowel resection surgery with termino-terminal anastomosis by laparoscopic approach in a scheduled manner admitted to a Resuscitation Unit from november 2020 to march 2022 evaluating the appearance of certain clinical complications base don the tympanic temperatura measured in the immediate postoperative period. Results: Our study population consisted of 181 patients. The mean age was 67 years. Of the patients, 51.4% were men and 48.6% were women. The mean BMI calculated was 27.7, 44.8% of the patients were classified as ASA III. Twenty-six percent of patients underwent right hemicolectomy, 34.8% sigmoidectomy, 18.8% anterior rectal resection, 11% segmental colon resection, 2.2% total colectomy, 0.6% TAMIS, and 6.6% left hemicolectomy. The mean duration of surgery was 254.55 minutes, the mean stay in the Resuscitation Unit of patients without hypothermia was 2.06 days and with hypothermia was 5.52 days. The mean total hospital stay for patients without hypothermia was 8.34 days and for patients with hypothermia was 14.92 days. We analyzed the possible postoperative complications in our study population, observing that perioperative hypothermia (<36ºC) was statistically significantly (p<0.05) associated with increased hospital stay and stay in resuscitation, with the development of coagulopathy, need for transfusion of blood products, surgical wound infection, intra-abdominal infection, renal function impairment, appearance of cardiac arrhythmias and with increasing age and higher step in the ASA classification. Conclusions: Maintenance of normothermia in the immediate postoperative period is related to a decrease in postoperative complications. In older patients and with higher ASA classification, hypothermia is more frequent. The presence of hypothermia is related to increased hospital stay, increased need for transfusion of blood products, development of coagulopathy, intra-abdominal infection, surgical wound infection, renal failure and cardiac arrhythmias.