title: Independent risk factors for postoperative shivering.
abstract: Postoperative shivering (PAS) is uncomfortable for patients and potentially risky. In this observational trial we sought to identify independent risk factors for PAS after general anesthesia. Potential risk factors for PAS were recorded in 1340 consecutive patients. Signs of shivering, peripheral and core temperature, and thermal comfort were recorded in the postanesthetic care unit. The data were split into an evaluation data set (n = 1000) and a validation data set (n = 340). The first was used to identify independent risk factors for PAS and to formulate a risk score using backward-elimination logistic regression analysis. The proposed model was subsequently tested for its discrimination and calibration properties using receiver operating characteristic (ROC)-curve analysis and linear correlation between the predicted and the actual incidences of PAS in the validation group. The incidence of PAS was 11.6%. There were three major risk factors: young age, endoprosthetic surgery, and core hypothermia, with age being the most important. The risk score derived from this analysis had a reasonable discriminating power, with an area under the ROC-curve of 0.69 (95% confidence interval, 0.60-0.78; P < 0.0001). Furthermore the equation of the calibration curve (y = 0.69x + 6; R2= 0.82; P < 0.05) indicated a good and statistically significant agreement between predicted and actual PAS incidence. Postoperative shivering can be predicted with acceptable accuracy using the four risk factors identified in the present study. The presented model may serve as a clinical tool to help clinicians to rationally administer prophylactic antishivering drugs.
authors.affiliation: Department of Anesthesiology and Critical Care, Philipps-University Marburg, Germany; Department of Anesthesiology, University of Würzburg, Germany; Outcomes Research ™ Institute and Departments of Anesthesiology and Pharmacology, University of Louisville, Louisville, Kentucky.
authors.forename: Leopold H J
authors.initials: LHJ
authors.lastname: Eberhart
authors.forename: Friederike
authors.initials: F
authors.lastname: Döderlein
authors.forename: Gudrun
authors.initials: G
authors.lastname: Eisenhardt
authors.forename: Peter
authors.initials: P
authors.lastname: Kranke
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
authors.forename: Alexander
authors.initials: A
authors.lastname: Torossian
authors.forename: Hinnerk
authors.initials: H
authors.lastname: Wulf
authors.forename: Astrid M
authors.initials: AM
authors.lastname: Morin
mesh_terms: D000328:Adult; D000368:Aged; D002138:Calibration; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D012307:Risk Factors; D012768:Shivering