• N Ziolkowski, A D Rogers, W Xiong, B Hong, S Patel, B Trull, and M G Jeschke.
• Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre, Toronto, Canada; Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Canada.
• Burns. 2017 Dec 1; 43 (8): 167316811673-1681.

BackgroundProlonged operative time and intraoperative hypothermia are known to have deleterious effects on surgical outcomes. Although millions of burn injuries undergo operative treatment globally every year, there remains a paucity of evidence to guide perioperative practice in burn surgery. This study evaluated associations between hypothermia and operative time on post-operative complications in acute burn surgery.MethodA historical cohort study from January 1, 2006 to October 31, 2015 was completed at an American Burn Association verified burn centre. 1111 consecutive patients undergoing acute burn surgery were included, and 2171 surgeries were analyzed. Primary outcomes included post-operative complications, defined a priori as either infectious or noninfectious. Statistical analysis was undertaken using a modified Poisson model for relative risk, adjusted for total body surface area, inhalation injury, co-morbidities, substance abuse, and age.ResultsThe mean operative time was 4.4h (SD 3.7-4.7h; range 0.58-11h), and 18.6% of patients became hypothermic intra-operatively. Operative time was independently associated with the incidence of hypothermia (p<0.05), and both infectious (RR1.5; 1.2-1.9, p<0.0004) and non-infectious complications (RR2.3; 1.3-4.1, p<0.0066). In patients with major burns (TBSA≥20%), hypothermia predisposed to infectious (RR1.3; 1.1-1.5, p<0.0017) and non-infectious complications (RR1.7; 1.2-2.5; p<0.0049). Risk stratification revealed that hypothermic patients with major burns undergoing prolonged surgery had an increased risk of both infectious (RR1.4; 1.1-1.7, p<0.0068) and non-infectious complications (RR1.8; 1.1-3.0, p<0.0132) when compared with those without these risk factors.ConclusionsPatients who undergo prolonged surgeries and become hypothermic are more likely to develop complications. We therefore advocate for diligent adherence to strategies to prevent hypothermia and recommend limiting operative time in clinical circumstances where intraoperative measures are unlikely to adequately prevent hypothermia.Copyright © 2017 Elsevier Ltd and ISBI. All rights reserved.

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