Intraoperative Hypothermia and Surgical Site Infections in Patients with Class I/Clean Wounds: A Case-Control Study.
BACKGROUND
Numerous surgical quality metrics focus on prevention of unintentional perioperative hypothermia due, in part, to the association between hypothermia and surgical site infections (SSI). However, few studies have comprehensively evaluated the relationship between these metrics and SSI. In this study, we evaluated individual components of 1 set of hypothermia metrics to determine their association with SSI.


METHODS
Patients with clean (class I) wounds who developed an SSI within 30 days after surgery, from January 2003 to December 2012, in 1 of 5 surgical specialties, were matched to specialty-specific controls without SSI. Stratified logistic regression models were used to assess the associations between (1) compliance with the Surgical Care Improvement Project (SCIP) Performance Measure, Surgery Patients with Perioperative Temperature Management (SCIP-Inf-10), overall and its components (maintenance of minimum body temperature and use of an active warming device) and SSI and (2) intraoperative hypothermia.


RESULTS
In both univariate and adjusted analyses using adjusted odds ratios (OR), SCIP-Inf-10 compliance was not associated with SSI (composite compliance OR 0.89, 95% CI 0.63 to 1.24; temperature compliance OR 0.92, 95% CI 0.78 to 1.09; forced-air warming device compliance OR 0.95, 95% CI 0.76 to 1.19). Higher intraoperative nadir temperature (OR 1.19, 95% CI 1.05 to 1.35) was associated with SSI. Percent of time exposed to a temperature < 36°C (OR 0.98, 95% CI 0.96 to 1.01), and cumulative hypothermic exposure (°C*h <36°C) (OR 0.98, 95% CI 0.90 to 1.05) were not associated with SSI.


CONCLUSIONS
Intraoperative hypothermia was not significantly associated with SSI. These results suggest that development of compliance metrics may not be an effective strategy for SSI reduction in class I surgical wounds.
Department of Anesthesiology, Mayo Clinic, Rochester, MN. Electronic address: brown.michael3@mayo.edu.
Michael J
MJ
Brown
Department of Anesthesiology, Mayo Clinic, Rochester, MN.
Timothy B
TB
Curry
Department of Anesthesiology, Mayo Clinic, Rochester, MN.
Joseph A
JA
Hyder
Department of Infection Prevention and Control, Mayo Clinic, Rochester, MN.
Elie F
EF
Berbari
Division of General Surgery, Department of Surgery, Mayo Clinic, Rochester, MN.
Mark J
MJ
Truty
Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
Darrell R
DR
Schroeder
Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN.
Andrew C
AC
Hanson
Department of Anesthesiology, Mayo Clinic, Rochester, MN.
Daryl J
DJ
Kor
D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007035:Hypothermia / Q000209:etiology / Q000517:prevention & control*; D007431:Intraoperative Complications / Q000517:prevention & control*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods* / Q000592:standards; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology / Q000517:prevention & control*; D016896:Treatment Outcome