R. M. Landisch2, R. Massoumi3, M. Christensen1, A. J. Wagner1,2 1Children’s Hospital Of Wisconsin,Pediatric Surgery,Milwaukee, WI, USA 2Medical College Of Wisconsin,Surgery,Milwaukee, WI, USA 3University Of California – Los Angeles,Surgery,Los Angeles, CA, USA
Introduction: Perioperative hypothermia results in decreased nutrient and oxygen delivery to tissues secondary to vasoconstriction. In recent adult studies, it correlates with increased morbidity from infectious complications. Gastroschisis, a relatively common congenital abdominal wall defect whereby much of the viscera are exposed at birth, places infants at risk for hypothermia by nature of excessive heat loss. Although hypothermia is a known cause of mortality in patients with gastroschisis, the rate of infectious complications in this at-risk cohort has not yet been delineated.
Methods: A retrospective cohort study was performed at our single tertiary-referral hospital, evaluating all gastroschisis infants who underwent operative closure. Patient and operative characteristics were assessed. Intraoperative temperatures were recorded, defining hypothermia as mild (35.5-35.9°C), moderate (35.0-35.4 °C), or severe (< 35 °C). Temperature nadirs were classified as occurring during the procedure (i.e., surgeon operative period) vs anesthetic period. The primary outcome was 30-day surgical site infections. Secondary outcome measures included additional infectious episodes requiring antibiotic therapy.
Results: Among 43 gastroschisis neonates undergoing operative closure, 21 (48.8%) had hypothermia, which was classified as mild in 2 (9.5%), moderate in 8 (38.1%) and severe in 11 (52.4%). The temperature nadir occurred during the procedural vs anesthesia period in 13 (61.9%) vs 8 (38.0%) infants, respectively. Infectious complications were found in 15 (35.9%) patients, with 23.3% of the gastroschisis cohort developing surgical site infections (9 incisional, 1 deep space), with no significant association to hypothermia. Hypothermic and normothermic cohorts were similar with respect to patient characteristics and procedural time, including a comparable prevalence of complex gastroschisis between cohorts. Notably, normothermic infants were more likely to have silos placed with delayed closure than hypothermic patients (63.6% vs 23.8%, p = 0.01), but on subgroup analysis procedural times and infectious rates were again similar between silo and non-silo infants.
Conclusion: Infants with gastroschisis are at high risk for hypothermia and infectious complications. Patients with silos and delayed closure are less subject to temperature lability without decreased infectious risk. A multi-institutional study with greater power is needed to further investigate the relationship between perioperative hypothermia and surgical infectious complications.
