The relationship between perioperative temperature and adverse outcomes after off-pump coronary artery bypass graft surgery

Hannan, Edward L.; Samadashvili, Zaza; Wechsler, Andrew; Jordan, Desmond; Lahey, Stephen J.; Culliford, Alfred T.; Gold, Jeffrey P.; Higgins, Robert S.D.; Smith, Craig R.

doi:10.1016/j.jtcvs.2009.11.057

« Previous Next »The Journal of Thoracic and Cardiovascular Surgery
Volume 139, Issue 6 , Pages 1568-1575.e1, June 2010

The relationship between perioperative temperature and adverse outcomes after off-pump coronary artery bypass graft surgery

Edward L. Hannan, PhD
- University at Albany, State University of New York, Albany, NY
- Address for reprints: Edward L. Hannan, PhD, Distinguished Professor and Associate Dean for Research, School of Public Health, State University of New York, University at Albany, One University Place, Rensselaer, NY 12144-3456.
Zaza Samadashvili, MD
- University at Albany, State University of New York, Albany, NY
Andrew Wechsler, MD
- Drexel University College of Medicine, Philadelphia, Pa
Desmond Jordan, MD
- Columbia-Presbyterian Medical Center, New York, NY
Stephen J. Lahey, MD
- Maimonides Medical Center, New York, NY
Alfred T. Culliford, MD
- New York University Medical Center, New York, NY
Jeffrey P. Gold, MD
- Medical University of Ohio, Toledo, Ohio
Robert S.D. Higgins, MD
- Rush University Medical Center, Chicago, Ill
Craig R. Smith, MD
- Columbia-Presbyterian Medical Center, New York, NY

Received 15 July 2009; received in revised form 17 September 2009; accepted 26 November 2009. published online 18 February 2010.

Objective

The study objective was to determine predictors of hypothermia and hyperthermia, and the impact of hypothermia and hyperthermia on postoperative outcomes for off-pump coronary artery bypass grafting.

Methods

We performed a retrospective study of 2294 patients who underwent off-pump coronary artery bypass grafting in New York in 2007. Patients were classified as moderately to severely hypothermic (≤34.5°C), mildly hypothermic (34.6°C–35.9°C), or mildly hyperthermic (37.5°C–38.8°C) after leaving the operating room. Significant independent predictors of these temperature states and the independent impact of each of these states on in-hospital mortality and complications were identified.

Results

A total of 37.7% of patients were mildly hypothermic, 9.0% of patients were moderately to severely hypothermic, and 5.6% of patients were mildly hyperthermic. Significant independent predictors for postoperative hypothermia included older age, female gender, lower body surface area, congestive heart failure, higher ventricular function, non-Hispanic ethnicity, single/double-vessel disease, low postoperative hematocrit, previous cardiac surgery, race other than white or black, and organ transplant. Patients with moderate to severe hypothermia had significantly higher risk-adjusted in-hospital mortality than patients with normothermia (adjusted odds ratio 3.00; 95% confidence interval, 1.11–8.08). Patients with mild hyperthermia also had significantly higher mortality (adjusted odds ratio 5.04; 95% confidence interval,1.18–21.55). Patients with either mild or moderate to severe hypothermia had significantly higher rates of respiratory failure and unplanned operations, and patients with mild hyperthermia had a significantly higher rate of respiratory failure than normothermic patients.

Conclusion

It is important to maintain normal postsurgical core temperatures in patients who have undergone cardiac surgery to minimize or avoid death and complications.

CTSNet classification: 23

Abbreviations and Acronyms: CABG, coronary artery bypass grafting, CI, confidence interval, OR, odds ratio