Clinical Impact of Intraoperative Hypothermia on Outcomes Following Esophagectomy for Esophageal Cancer

Body temperature monitoring and active thermal management are considered essential to maintain normothermia during elective surgery; however, few studies have specifically studied patients undergoing esophagectomy. This study evaluated the influence of intraoperative hypothermia on surgical outcomes in patients undergoing esophagectomy.

Overall, 501 patients who underwent esophagectomy for esophageal cancer were retrospectively analyzed. We evaluated the associations of body temperature during esophagectomy with surgical outcomes using multivariable logistic regression and restricted cubic spline models.

Postoperatively, 49.5% of patients experienced complications, including anastomotic leakage (10.0%), pneumonia (19.7%), and severe (Clavien-Dindo grade III or higher) complications (22.2%). When illustrating the associations between body temperature and outcomes using a restricted cubic spline model, intraoperative temperature exhibited negative value-dependent associations with overall postoperative complications, anastomotic leakage, pneumonia, and severe complications. Based on the overall complication model, we used a threshold of 35°C for hypothermia, with 397 (79.2%) and 104 (20.8%) patients assigned to the normothermia and hypothermia groups, respectively. The hypothermia group had a higher likelihood of overall postoperative complications (risk-adjusted odds ratio [OR] 3.00, 95% confidence interval [CI] 1.88-4.79), anastomotic leakage (risk-adjusted OR 2.62, 95% CI 1.38-4.96), pneumonia (risk-adjusted OR 1.89, 95% CI 1.12-3.18), and severe complications (risk-adjusted OR 1.94, 95% CI 1.18-3.19).

Intraoperative hypothermia (<35°C) was significantly associated with increased probabilities of overall postoperative complications, anastomotic leakage, pneumonia, and severe complications following esophagectomy.