Acute Crit Care.  2019 Feb;34(1):53-59. 10.4266/acc.2019.00255.

Association of Immediate Postoperative Temperature in the Surgical Intensive Care Unit with 1-Year Mortality: Retrospective Analysis Using Digital Axillary Thermometers

Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea.
  • 2Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, Korea. songoficu@outlook.kr
  • 3Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Korea.

Abstract

BACKGROUND
Postoperative body temperature is closely associated with prognosis although there is limited research regarding this association at postoperative intensive care unit (ICU) admission. Furthermore, no studies have used digital axillary thermometers to measure postoperative body temperature. This study investigated the association between mortality and postoperative temperature measured using a digital axillary thermometer within 10 minutes after ICU admission.
METHODS
This retrospective observational study evaluated data from adult patients admitted to an ICU after elective or emergency surgery. The primary outcome was 1-year mortality after ICU admission. Multivariable logistic regression analysis with restricted cubic splines was used to evaluate the association between temperature and outcomes.
RESULTS
We evaluated data from 5,868 patients admitted between January 1, 2013 and May 31, 2016, including 5,311 patients (90.5%) who underwent noncardiovascular surgery and 557 patients (9.5%) who underwent cardiovascular surgery. Deviation from the median temperature (36.6℃) was associated with increases in 1-year mortality (≤ 36.6℃: linear coefficient, −0.531; P < 0.001 and ≥36.6℃: spline coefficient, 0.756; P < 0.001). Similar statistically significant results were observed in the noncardiovascular surgery group, but not in the cardiovascular surgery group.
CONCLUSIONS
An increase or decrease in body temperature (vs. 36.6℃) measured using digital axillary thermometers within 10 minutes of postoperative ICU admission was associated with increased 1-year mortality. However, no significant association was observed after cardiovascular surgery. These results suggest that postoperative temperature is associated with long-term mortality in patients admitted to the surgical ICU in the postoperative period.

Keyword

critical care; intensive care units; temperature

MeSH Terms

Adult
Body Temperature
Critical Care*
Emergencies
Humans
Intensive Care Units
Logistic Models
Mortality*
Observational Study
Postoperative Period
Prognosis
Retrospective Studies*
Thermometers*

Figure

  • Figure 1. Restricted cubic splines between initial postoperative axillary temperature in the intensive care unit (ICU) and postoperative 1-year mortality. The results are shown for (A) noncardiovascular surgery and (B) cardiovascular surgery. Body temperature was defined as the first temperature measured using a digital axillary thermometer within 10 minutes of entry into the ICU. a The median value of the distribution of first postoperative body temperature in the ICU.


Reference

1. Vermeulen H, Storm-Versloot MN, Goossens A, Speelman P, Legemate DA. Diagnostic accuracy of routine Postoperative body temperature measurements. Clin Infect Dis. 2005; 40:1404–10.
Article
2. Bush HL Jr, Hydo LJ, Fischer E, Fantini GA, Silane MF, Barie PS. Hypothermia during elective abdominal aortic aneurysm repair: the high price of avoidable morbidity. J Vasc Surg. 1995; 21:392–400.
Article
3. Karalapillai D, Story D. Hypothermia on arrival in the intensive care unit after surgery. Crit Care Resusc. 2008; 10:116–9.
4. Slotman GJ, Jed EH, Burchard KW. Adverse effects of hypothermia in Postoperative patients. Am J Surg. 1985; 149:495–501.
Article
5. Frank SM, Fleisher LA, Breslow MJ, Higgins MS, Olson KF, Kelly S, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events: a randomized clinical trial. JAMA. 1997; 277:1127–34.
Article
6. Kurz A, Sessler DI, Lenhardt R, Study of Wound Infection, Temperature Group. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. N Engl J Med. 1996; 334:1209–15.
Article
7. Grocott HP, Mackensen GB, Grigore AM, Mathew J, Reves JG, Phillips-Bute B, et al. Postoperative hyperthermia is associated with cognitive dysfunction after coronary artery bypass graft surgery. Stroke. 2002; 33:537–41.
Article
8. Kongsayreepong S, Chaibundit C, Chadpaibool J, Komoltri C, Suraseranivongse S, Suwannanonda P, et al. Predictor of core hypothermia and the surgical intensive care unit. Anesth Analg. 2003; 96:826–33.
Article
9. Karalapillai D, Story DA, Calzavacca P, Licari E, Liu YL, Hart GK. Inadvertent hypothermia and mortality in Postoperative intensive care patients: retrospective audit of 5050 patients. Anaesthesia. 2009; 64:968–72.
Article
10. Baucom RB, Phillips SE, Ehrenfeld JM, Muldoon RL, Poulose BK, Herline AJ, et al. Association of perioperative hypothermia during colectomy with surgical site infection. JAMA Surg. 2015; 150:570–5.
Article
11. Marrie RA, Dawson NV, Garland A. Quantile regression and restricted cubic splines are useful for exploring relationships between continuous variables. J Clin Epidemiol. 2009; 62:511–7. e1.
Article
12. Sund-Levander M, Forsberg C, Wahren LK. Normal oral, rectal, tympanic and axillary body temperature in adult men and women: a systematic literature review. Scand J Caring Sci. 2002; 16:122–8.
Article
13. Yi J, Lei Y, Xu S, Si Y, Li S, Xia Z, et al. Intraoperative hypothermia and its clinical outcomes in patients undergoing general anesthesia: national study in China. PLoS One. 2017; 12:e0177221.
Article
14. Eddy VA, Morris JA Jr, Cullinane DC. Hypothermia, coagulopathy, and acidosis. Surg Clin North Am. 2000; 80:845–54.
Article
15. Sessler DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology. 2008; 109:318–38.
Article
16. Pile JC. Evaluating Postoperative fever: a focused approach. Cleve Clin J Med. 2006; 73 Suppl 1:S62–6.
Article
17. Lewis ME, Al-Khalidi AH, Townend JN, Coote J, Bonser RS. The effects of hypothermia on human left ventricular contractile function during cardiac surgery. J Am Coll Cardiol. 2002; 39:102–8.
Article
18. Kiekkas P, Fligou F, Igoumenidis M, Stefanopoulos N, Konstantinou E, Karamouzos V, et al. Inadvertent hypothermia and mortality in critically ill adults: systematic review and meta-analysis. Aust Crit Care. 2018; 31:12–22.
Article
19. Erickson RS, Kirklin SK. Comparison of ear-based, bladder, oral, and axillary methods for core temperature measurement. Crit Care Med. 1993; 21:1528–34.
Article
20. Uslu S, Ozdemir H, Bulbul A, Comert S, Bolat F, Can E, et al. A comparison of different methods of temperature measurements in sick newborns. J Trop Pediatr. 2011; 57:418–23.
Article
21. Rubia-Rubia J, Arias A, Sierra A, Aguirre-Jaime A. Measurement of body temperature in adult patients: comparative study of accuracy, reliability and validity of different devices. Int J Nurs Stud. 2011; 48:872–80.
Article
22. Tabor MW, Blaho DM, Schriver WR. Tympanic membrane perforation: complication of tympanic thermometry during general anesthesia. Oral Surg Oral Med Oral Pathol. 1981; 51:581–3.
Article
Full Text Links
  • ACC
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr