Title: Hypothermia and Quality of Recovery in Cancer Patients

Background and Goal of Study: 
Intra and postoperative hypothermia has been linked with several adverse complications that can affect the patient’s outcome. Hypothermia could also been felt as a discomfort symptom and could be linked with a decreased quality of recovery in the postoperative period. The aim of this study was to evaluate the incidence of hypothermia and assess its impact in the recovery during the postoperative period of a group of cancer patients.

Material and methods: 
After study approval by ethics committee, an observational prospective study was conducted. Patients submitted to elective cancer surgery with a curative intent admitted at the post anesthesia care unit (PACU) (from Jun 2016 to Oct 2016) were included. Exclusion criteria: age < 18 years old and inability to give informed consent. Patients with an auricular temperature < 35ºC at PACU admission were classified as patients with hypothermia. Quality of Recovery was evaluated using Post-Operative Quality of Recovery Scale (PQRS) before surgery (T0), at 15 and 40 min, 24h and 72h, and Quality of Recovery-15 (QoR-15) before (T0) and 24 hours (T24h) after surgery. Recovery was defined as a return to baseline or better values for all questions in each domain. Patient´s demographics and perioperative data were collected. The Chi-square, Fischer´s exact or Mann-Whitney U tests were used for comparisons.

Results and Discussion: 
A total of 123 patients were included. The incidence of hypothermia was 30%. There were no differences in QoR-15 at TO, but at T24h hypothermic patients had lower median scores in QoR-15 (106.50 vs 115.00, p=0.039). PQRS showed no differences in overall rate of recovery in all domains evaluated together, we only found differences in respect to the physiologic domain with non-hypothermic having higher scores of recovery at 15 (p=0.016) and 40 min (p=0.001) compared to hypothermic patients. Richmond Agitation Sedation Scale (RASS) scored lower in hypothermic patients. Length of PACU (180.00 vs 124.00, median min, p=0.011) and hospital (7.00 vs 5.50, median days, p=0.001) stay were higher in the hypothermic patients compared to non-hypothermic

Conclusion (s): 
QoR-15 revealed a poor quality of recovery in hypothermic patients at 24h. PQRS showed no differences in overall rate of recovery in all domains together. Length of PACU and hospital stay were higher in hypothermic patients, suggesting that hypothermia might have an adverse impact in postoperative recovery.

Hypothermia and quality of recovery in surgical cancer patients