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Multivariate Analysis of Factors Associated with Maternal Temperature After Cesarean Delivery.
Abstract Number: T 2
Abstract Type: Original Research
BACKGROUND: Perioperative hypothermia can lead to important adverse outcomes e.g., blood loss, wound infection, and delayed recovery.(1,2) The influence of neuraxial anesthesia (NA), obstetric, and perioperative factors on maternal temperature (MT) after cesarean delivery (CD) has not been adequately elucidated. The aims of this retrospective cohort study were to assess the incidence of hypothermia and identify factors associated with post-CD MT after NA.
METHODS: After IRB approval, data was abstracted from the medical records of 225 women who underwent CD in 2011 with NA and without perioperative warming. Based on prior research and biologic plausibility, demographic, obstetric, and perioperative factors that were considered as potential predictors for post-CD MT included: maternal age, BMI, gestational age, surgical duration, total estimated blood loss, intraoperative fluids, phenylephrine dose, chorioamnionitis, singleton/multiple gestation, gestational diabetes, mode of NA (single shot spinal, combined spinal-epidural, epidural top-up), presence/absence of labor pre-CD. We performed multiple linear regression with backward variable selection to identify factors associated with post-CD MT (probability-to-retain=0.05). Presence/absence of labor was retained in the final model. Data presented as n (%), mean (SD), median [IQR]; P <0.05 as statistically significant.
RESULTS: Mean post-CD MT was 36.6 (0.3)°C. The incidence of post-CD hypothermia (MT≤ 36°C) was 2.2%. Demographic, obstetric and perioperative data are presented in Table 1. Spinal-based anesthetic techniques were associated with a decrease in post-CD MT vs. epidural ‘top-ups’(Table 2). No other demographic, obstetric, surgical or perioperative factors were significantly associated with MT.
DISCUSSION: The low incidence of post-CD hypothermia suggests that perioperative warming may not be necessary in all patients undergoing CD with NA. In our multivariate model, mode of NA was the only factor independently associated with post-CD MT. This finding is supported by prior research indicating that core temperatures are lower after spinal anesthesia compared to epidural anesthesia.(2) However, mode of NA only accounted for 20% of the variance in post-CD MT in our study. To better identify women who will benefit from perioperative warming, future studies are required to refine predictive factors for post-CD hypothermia.
REFS: (1) Anesthesiology 2008;109:318-38 (2) Reg Anesth Pain Med 1998;23:418-23.