The Effect of Induced Hypothermia on Postoperative Outcomes Following Hyperthermic Intraperitoneal Chemotherapy: A Negative Finding

Ming-Chi Yang,1 Kai-Lieh Lin,1 Kuan-Chih Chung,1 Sheng-En Chou,2 Min Chien,3 Chih-Yi Hsu1 1Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 2Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 3Administrative Department, Min-Jhong Hospital, Pingtung, TaiwanCorrespondence: Chih-Yi Hsu, Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital, No. 123, Dapi Road, Niaosong District, Kaohsiung, 83301, Taiwan, Tel +886-87636672, Email [email protected]: The optimal strategy for body temperature management during cytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) remains controversial. This study aimed to assess whether intentionally cooling the core body temperature (CBT) to hypothermia (< 35°C) before the HIPEC phase improves postoperative outcomes.Patients and Methods: In this retrospective cohort study, we analyzed 73 patients who underwent CRS plus HIPEC, grouped by CBT immediately before HIPEC: CBT ≥ 35°C (n=51) and CBT < 35°C (n=22). Primary outcomes including time to extubation and Clavien-Dindo classification. Secondary outcomes including length of stay (LOS), ICU stay, postoperative acute kidney injury (AKI) and reintubation event. Intraoperative parameters such as hemodynamic status, blood loss, transfusion requirements, and intravenous (IV) fluid amount were also compared.Results: Compared to the normothermia group, patients in the hypothermia group had significantly longer time to extubation (median 11.5 vs 8.0 hours, p = 0.0314), greater blood loss (median 350 vs 150 mL, p = 0.0045), higher leukocyte-poor red blood cells transfusion units (p = 0.0016) and increased total IV fluid amount (p = 0.0049). Delayed extubation, defined as occurring more than 12 hours after surgery, appeared to be independently associated with hypothermia (odds ratio [OR] 6.31, 95% confidence interval [CI] 1.11– 35.70, P = 0.037) and total IV fluid administration (per 100 mL; OR 1.05, 95% CI 1.00– 1.10, P = 0.042) in multivariate analysis.Conclusion: Actively inducing hypothermia before the HIPEC phase did not demonstrate improved postoperative outcomes and may be associated with delayed extubation, greater blood loss, higher transfusion requirements, and increased IV fluid administration.Keywords: body temperature, cytoreduction surgical procedures, perioperative care, airway extubation