Impact of perioperative temperature on postoperative surgical site infections: Improving the predictability of standard risk indices.

摘要

This retrospective cohort study was designed to examine the impact of perioperative temperature on prediction of postoperative surgical site infections (SSIs) among patients who underwent general abdominal surgery at San Francisco General Hospital. The current extant risk indices, Study on the Efficacy of Nosocomial Infection Control (SENIC) and National Nosocomial Infection Surveillance (NNIS) risk indices, and a modified risk index, in which a factor related to perioperative temperature was added to the extant risk indices, were compared in terms of predictability of SSIs.; Two hundred and thirty patients were followed by a total medical chart review within 30 days after surgery. SSIs were identified using the definitions of the Centers for Disease Control and Prevention. Of the final sample of 230 surgical patients, nearly 54% were trauma patients, yielding a cumulative SSI incidence of 22.6% for this high-risk group. Intraoperative core temperatures were measured at the following points: initial and final core temperatures, the lowest core temperature, and the minutes of the core temperature less than 35°C. Unlike the findings of previous studies, none of these perioperative temperature measurements were statistically significant at a p-value of less than 0.05. However, there were statistically significant differences between patients with and without SSIs in the change between the initial and final core temperatures (p = .001) as well as the change between the initial and lowest core temperatures (p = .031). Both the SENIC (p .01) and NNIS (p .01) risk indices were good predictors for postoperative SSIs. Logistic regression analysis showed that the change between the initial and final core temperatures, controlling for the influence of the perioperative factors included each risk index, was an important predictor of SSIs: AOR = 2.923 for temperature change when added to SENIC factors; AOR = 2.101 for temperature change when added to NNIS factors.; The addition of temperature change during surgery to the extant risk indices for SSIs both improves the ability to predict this serious adverse event and provides nurses and other healthcare workers with a potentially modifiable factor to reduce risk.