Guidelines for Complications of Cancer Treatment Vol VIII Part B

Perioperative Normothermia to Reduce the Incidence ofSurgical-Wound Infection and Shorten HospitalizationKurz A, Sessler DI, Lenhardt R. The Study of WoundInfection and, for Temperature Group. N Engl J Med1996;334:1209-15.Background Mild perioperative hypothermia, which iscommon during major surgery, may promote surgical-woundinfection by triggering thermoregulatory vasoconstriction,which decreases subcutaneous oxygen tension. Reduced levelsof oxygen in tissue impair oxidative killing by neutrophils anddecrease the strength of the healing wound by reducing thedeposition of collagen. Hypothermia also directly impairsimmune function. Authors tested the hypothesis thathypothermia both increases susceptibility to surgical-woundinfection and lengthens hospitalization.Methods Two hundred patients undergoing colorectal surgerywere randomly assigned to routine intraoperative thermal care(the hypothermia group) or additional warming (thenormothermia group). The patients’ anesthetic care wasstandardized, and they were all given cefamandole andmetronidazole. In a double-blind protocol, their wounds wereevaluated daily until discharge from the hospital and in theclinic after two weeks; wounds containing culture-positive puswere considered infected. The patients’ surgeons remainedunaware of the patients’ group assignments.Results The mean (±SD) final intraoperative core temperaturewas 34.7±0.6°C in the hypothermia group and 36.6±0.5°C inthe normothermia group (P