Correlation between intraoperative hypothermia and perioperative morbidity in patients with head and neck cancer

Objective: To determine if intraoperative hypothermia correlates with perioperative complications in patients undergoing head and neck surgery with regional or free flap reconstructions. Design: Retrospective medical chart review. Setting: Academic tertiary care hospital. Patients: A sample of 136 patients who underwent ablative surgery for head and neck cancer and subsequently required reconstruction with free tissue or a regional flap in the last 10 years. Main Outcome Measures: Rate of early (within 3 weeks of surgery) perioperative complications and its correlation with patient hypothermia (core body temperature, <35°C). Results: There were 43 patients with complications. Two patients died. Complications included 10 partial or total flap losses, 9 hematomas, 8 episodes of pneumonia, 7 fistulas, 7 wound infections, 5 wound breakdowns, and 2 cerebrospinal fluid leaks. Factors that did not correlate with complications included having received prior chemotherapy (P=.84), having stage IV cancer (P=.16), sex (P=.43), tobacco use (P=.58), prior radiotherapy (P=.30), the presence of comorbidities (P=.43), age (P=.27), length of surgery (P=.63), and the use of blood products perioperatively (P=.73). Patients who were hypothermic had a significantly higher rate of complications that normothermic patients (P=.002). Stepwise logistic regression analysis identified intraoperative hypothermia as a significant independent predictor for the development of early perioperative complications (odds ratio, 5.122; 95% confidence interval, 1.317-19.917). Conclusions: Intraoperative hypothermia in head and neck surgery is correlated with perioperative complications. Maintaining normothermia through aggressive warming may decrease the incidence of perioperative morbidity for these patients.