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The effects of prolonged intraoperative hypothermia on patient outcomes in immediate, implant-based breast reconstruction

Published:November 19, 2022DOI:https://doi.org/10.1016/j.bjps.2022.11.006

      ABSTRACT

      Background

      The importance of thermoregulation in surgical procedures has become a recent focus for anesthesiologists and surgeons to improve patient outcomes. In breast surgery, maintenance of normothermia has been shown to reduce surgical site infections. However, there is a paucity of information evaluating the relationship between intraoperative core body temperatures and reconstructive surgical outcomes.

      Methods

      A retrospective review of patients that underwent immediate breast reconstruction following mastectomy from 2015 - 2020 was performed. Patients were organized into a majority normothermic (NT) group if patients spent greater than half of the operative time above or equal to 36°C or a majority hypothermic (HT) group if patients spent greater than or equal to half of the operative time below 36°C. Patient demographics, comorbidities, surgical techniques, and postoperative complications were recorded. Complications were classified according to the Clavien-Dindo classification. Univariate and multivariate statistics were utilized to assess for significant relationships.

      Results

      There were 329 total patients that met inclusion criteria with 174 in the NT group and 155 in the HT group, yielding 302 and 264 total breasts, respectively. There was no significant difference in rates of infection (p=1.0), seroma (p=0.27), hematoma (p=0.61), or wound dehiscence (p=1.0). However, patients in the HT group had significantly more overall ischemic complications (p=0.009) and specifically, grade IIIb ischemic complications (p=0.04). After controlling for tobacco use, body mass index, mastectomy pattern, radiation, operating surgeon, and mastectomy weight, multivariate analysis showed increased ischemic complications in the HT group (p=0.04).

      Conclusion

      Prolonged intraoperative hypothermia can increase the risk for the development of ischemic wounds such as tissue necrosis or eschar formation that require operative intervention. This presents reconstructive complications that increase both patient and health system burdens that could be addressed through maintenance of normothermia. Further studies utilizing real-time flap temperature would provide more accurate insight into relationship between temperature and implant-based breast reconstruction.

      Keywords

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