title: Postoperative hypothermia and surgical site infection following peritoneal insufflation with warm, humidified carbon dioxide during laparoscopic colorectal surgery: a cohort study with cost-effectiveness analysis.
abstract: Surgical Site Infection (SSI) occurs in 9 % of laparoscopic colorectal surgery. Warming and humidifying carbon dioxide (CO2) used for peritoneal insufflation may protect against SSI by avoiding postoperative hypothermia (itself a risk factor for SSI). This study aimed to assess the impact of CO2conditioning on postoperative hypothermia and SSI and to perform a cost-effectiveness analysis.
  
  
  
  A retrospective cohort study of patients undergoing elective laparoscopic colorectal resection was performed at a single UK specialist centre. The control group (n = 123) received peritoneal insufflation with room temperature, dry CO2, whereas the intervention group (n = 123) received warm, humidified CO2(using HumiGard™, Fisher & Paykel Healthcare). The outcomes were postoperative hypothermia, SSI and costs. Multivariate analysis was performed.
  
  
  
  A total of 246 patients were included in the study. The mean age was 68 (20-87) and mean BMI 28 (15-51). The primary diagnosis was cancer (n = 173), and there were no baseline differences between the groups. CO2conditioning significantly decreased the incidence of postoperative hypothermia (odds ratio 0.10, 95 % CI 0.04-0.23), with hypothermic patients found to be at increased risk of SSI (odds ratio 4.0, 95 % CI 1.25-12.9). Use of conditioned CO2significantly decreased the incidence of SSI by 66 % (p = 0.04). The intervention group incurred costs of £155 less per patient. The incremental cost-effectiveness ratio was negative.
  
  
  
  CO2conditioning during laparoscopic colorectal surgery is a safe, feasible and a cost-effective intervention. It improves the quality of surgical care relating to SSI and postoperative hypothermia.
authors.affiliation: ICENI Centre, Colchester Hospital, Turner Road, Colchester, Essex, CO4 5JL, UK. sam.mason06@imperial.ac.uk.
authors.forename: Sam E
authors.initials: SE
authors.lastname: Mason
authors.affiliation: ICENI Centre, Colchester Hospital, Turner Road, Colchester, Essex, CO4 5JL, UK.|Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK.
authors.forename: James M
authors.initials: JM
authors.lastname: Kinross
authors.affiliation: ICENI Centre, Colchester Hospital, Turner Road, Colchester, Essex, CO4 5JL, UK.
authors.forename: Jane
authors.initials: J
authors.lastname: Hendricks
authors.affiliation: ICENI Centre, Colchester Hospital, Turner Road, Colchester, Essex, CO4 5JL, UK.
authors.forename: Thanjakumar H
authors.initials: TH
authors.lastname: Arulampalam
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002245:Carbon Dioxide; D016022:Case-Control Studies; D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000601:surgery; D015179:Colorectal Neoplasms / Q000601:surgery*; D003107:Colorectal Surgery; D003362:Cost-Benefit Analysis; D003424:Crohn Disease / Q000601:surgery; D013505:Digestive System Surgical Procedures / Q000191:economics / Q000379:methods*; D004239:Diverticulitis, Colonic / Q000601:surgery; D017558:Elective Surgical Procedures; D005240:Feasibility Studies; D005260:Female; D006358:Hot Temperature; D006801:Humans; D006813:Humidity; D007035:Hypothermia / Q000191:economics / Q000453:epidemiology*; D007327:Insufflation; D010535:Laparoscopy / Q000191:economics / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010537:Peritoneum; D011028:Pneumoperitoneum, Artificial / Q000191:economics / Q000379:methods*; D011184:Postoperative Period; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000191:economics / Q000453:epidemiology*; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D002245:Carbon Dioxide
keywords: Carbon dioxide conditioning; Postoperative hypothermia; Surgical site infection