Association Between Intraoperative Hypothermia and Postoperative Pancreatic Fistula

Hypothermia frequently occurs during abdominal operations and negatively impacts postoperative outcomes. However, the association of hypothermia during pancreaticoduodenectomy (PD) with postoperative pancreatic fistula (POPF) remains unclear.

This retrospective study analyzed data from patients who underwent open PD at our institution from January 2018 through March 2024. Data on patient demographics, tumor characteristics, surgical outcomes (including POPF), and intraoperative temperature were collected. We sought to determine the incidence of intraoperative hypothermia, defined as an intraoperative core temperature below 36.0 °C, and investigated its association with POPF using multivariable logistic regression models.

Among 374 patients, 293 (78.3%) experienced hypothermia and 36 (9.6%) developed clinically relevant POPF. Multivariable analysis revealed that age ≥ 55 years (odds ratio [OR] 2.2; 95% confidence interval [CI] 1.2-4.0; p = 0.012) and operative time ≥ 435 min (OR 2.5; 95% CI 1.4-4.2; p = 0.001) were associated with increased incidence of hypothermia, while body mass index ≥ 25 kg/m² was protective (OR 0.4; 95% CI 0.2-0.6; p < 0.001). Factors associated with POPF included body mass index ≥ 25 kg/m² (OR 3.2; 95% CI 1.1-9.0; p = 0.031), nonpancreatic ductal adenocarcinoma histology (OR 10.3; 95% CI 3.8-27.8; p < 0.001), recent PD (from November 2020 to March 2024; OR 0.4; 95% CI 0.1-1.0; p = 0.045), and hypothermia (OR 3.4; 95% CI 1.0-11.3; p = 0.044).

Among patients undergoing open PD, hypothermia is common and is associated with increased risk for POPF. Further studies are needed to establish a validated and standardized definition of intraoperative hypothermia and to examine any associations with procedure-specific postoperative complications.