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Zhu K, Zhang ZX, Zhang M. Application value of machine learning models in predicting intraoperative hypothermia in laparoscopic surgery for polytrauma patients. World J Clin Cases 2024; 12:5513-5522. [PMID: 39188615 PMCID: PMC11269995 DOI: 10.12998/wjcc.v12.i24.5513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 05/30/2024] [Accepted: 06/20/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Hypothermia during laparoscopic surgery in patients with multiple trauma is a significant concern owing to its potential complications. Machine learning models offer a promising approach to predict the occurrence of intraoperative hypothermia. AIM To investigate the value of machine learning model to predict hypothermia during laparoscopic surgery in patients with multiple trauma. METHODS This retrospective study enrolled 220 patients who were admitted with multiple injuries between June 2018 and December 2023. Of these, 154 patients were allocated to a training set and the remaining 66 were allocated to a validation set in a 7:3 ratio. In the training set, 53 cases experienced intraoperative hypothermia and 101 did not. Logistic regression analysis was used to construct a predictive model of intraoperative hypothermia in patients with polytrauma undergoing laparoscopic surgery. The area under the curve (AUC), sensitivity, and specificity were calculated. RESULTS Comparison of the hypothermia and non-hypothermia groups found significant differences in sex, age, baseline temperature, intraoperative temperature, duration of anesthesia, duration of surgery, intraoperative fluid infusion, crystalloid infusion, colloid infusion, and pneumoperitoneum volume (P < 0.05). Differences between other characteristics were not significant (P > 0.05). The results of the logistic regression analysis showed that age, baseline temperature, intraoperative temperature, duration of anesthesia, and duration of surgery were independent influencing factors for intraoperative hypothermia during laparoscopic surgery (P < 0.05). Calibration curve analysis showed good consistency between the predicted occurrence of intraoperative hypothermia and the actual occurrence (P > 0.05). The predictive model had AUCs of 0.850 and 0.829 for the training and validation sets, respectively. CONCLUSION Machine learning effectively predicted intraoperative hypothermia in polytrauma patients undergoing laparoscopic surgery, which improved surgical safety and patient recovery.
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Affiliation(s)
- Kun Zhu
- The Second Department of Anesthesia, Tianjin Hospital, Tianjin 300211, China
| | - Zi-Xuan Zhang
- Department of War Rescue Training, Qingdao Special Servicemen Recuperation Center of PLA Navy, Qingdao 266001, Shandong Province, China
| | - Miao Zhang
- Department of Internal Medicine, Qingdao Fushan Elderly Apartments, Qingdao 266001, Shandong Province, China
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Cao B, Li Y, Liu Y, Chen X, Liu Y, Li Y, Wu Q, Ji F, Shu H. A multi-center study to predict the risk of intraoperative hypothermia in gynecological surgery patients using preoperative variables. Gynecol Oncol 2024; 185:156-164. [PMID: 38428331 DOI: 10.1016/j.ygyno.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/27/2024] [Accepted: 02/07/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES Hypothermia is highly common in patients undergoing gynecological surgeries under general anesthesia, so the length of hospitalization and even the risk of mortality are substantially increased. Our aim was to develop a simple and practical model to preoperatively identify gynecological surgery patients at risk of intraoperative hypothermia. METHODS In this retrospective study, we collected data from 802 patients who underwent gynecological surgery at three medical centers from June 2022 to August 2023. We further allocated the patients to a training group, an internal validation group, or an external validation group. The preliminary predictive factors for intraoperative hypothermia in gynecological patients were determined using the least absolute shrinkage and selection operator (LASSO) method. The final predictive factors were subsequently identified through multivariate logistic regression analysis, and a nomogram for predicting the occurrence of hypothermia was established. RESULTS A total of 802 patients were included, with 314 patients in the training cohort (mean age 48.5 ± 12.6 years), 130 patients in the internal validation cohort (mean age 49.9 ± 12.5 years), and 358 patients in the external validation cohort (mean age 47.6 ± 14.0 years). LASSO regression and multivariate logistic regression analyses indicated that body mass index, minimally invasive surgery, baseline heart rate, baseline body temperature, history of previous surgery, and aspartate aminotransferase level were associated with intraoperative hypothermia in gynecological surgery patients. This nomogram was constructed based on these six variables, with a C-index of 0.712 for the training cohort. CONCLUSIONS We established a practical predictive model that can be used to preoperatively predict the occurrence of hypothermia in gynecological surgery patients. CLINICAL TRIAL REGISTRATION chictr.org.cn, identifier ChiCTR2300071859.
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Affiliation(s)
- Bingbing Cao
- Department of Anesthesiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, PR China
| | - Yongxing Li
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital of Sun Yat-Sen University, Guangzhou 510120, PR China
| | - Yongjian Liu
- Department of Pain Management, Guangdong Second Provincial General Hospital, Guangzhou 510317, PR China
| | - Xiangnan Chen
- Department of Anesthesiology, Guangdong Women and Children Hospital, Guangzhou 510010, PR China
| | - Yong Liu
- Department of Anesthesiology, Third People's Hospital of Shenzhen, Shenzhen 518112, PR China
| | - Yao Li
- Department of Anesthesiology, Shenshan Medical Center, Memorial Hospital of Sun Yat-Sen University, Shanwei 516601, PR China
| | - Qiang Wu
- Department of Anesthesiology, Third People's Hospital of Shenzhen, Shenzhen 518112, PR China
| | - Fengtao Ji
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital of Sun Yat-Sen University, Guangzhou 510120, PR China.
| | - Haihua Shu
- Department of Anesthesiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, PR China; School of Medicine, South China University of Technology, Guangzhou 510080, PR China.
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Qian M, Ye Y, Zhou J. Effect of thermal insulation on preventing hypothermia during laparoscopic radical resection for colorectal cancer. Am J Transl Res 2024; 16:2158-2165. [PMID: 38883388 PMCID: PMC11170595 DOI: 10.62347/bkby6649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 05/13/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To evaluate the effect of thermal insulation nursing in the operating room on preventing hypothermia during laparoscopic radical resection of colorectal cancer. METHODS Sixty colorectal cancer patients undergoing laparoscopic radical resection from June 2022 to August 2023 were included. The research group received thermal insulation nursing interventions using medical heaters and infusion heaters, while the control group received routine nursing measures. Clinical data including vital signs, intraoperative and postoperative complications, recovery time, nursing satisfaction, and psychological and sleep status were compared between the two groups. RESULTS Thirty minutes after skin incision, both groups showed decreased body temperature, and systolic and diastolic blood pressure compared to pre-surgery levels, with no significant difference between groups (P > 0.05). However, the research group exhibited lower rates of intraoperative hypothermia, postoperative infection, and other complications, as well as shorter postoperative recovery times, hospital stays, anxiety, and depression scores compared to the control group (P < 0.05). Additionally, the research group demonstrated higher comfort scores, shorter sleep latency, longer actual sleep time, and higher nursing satisfaction rate (P < 0.05). CONCLUSION Thermal insulation nursing intervention in the operating room during laparoscopic radical resection of colorectal cancer contributes to maintaining vital signs, preventing intraoperative hypothermia, reducing postoperative complications, expediting recovery, and improving psychological well-being and sleep quality. This intervention enhances patient comfort and nursing satisfaction in perioperative care.
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Affiliation(s)
- Meidan Qian
- Shengzhou People's Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch) Shengzhou, Zhejiang, China
| | - Yuli Ye
- Shengzhou People's Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch) Shengzhou, Zhejiang, China
| | - Jujng Zhou
- Shengzhou People's Hospital (The First Affiliated Hospital of Zhejiang University Shengzhou Branch) Shengzhou, Zhejiang, China
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Shi CJ, Zhong BY. A Novel Device for Intraoperative Hypothermia Prevention in Patients with Lower Abdominal Surgery: A Prospective Randomized Single-Center Study. Ther Hypothermia Temp Manag 2022. [DOI: 10.1089/ther.2022.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Chun-Juan Shi
- Department of Operating Room, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Bao-Ying Zhong
- Department of Operating Room, Tongde Hospital of Zhejiang Province, Hangzhou, China
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Wittenborn J, Mathei D, van Waesberghe J, Zeppernick F, Zeppernick M, Tchaikovski S, Kowark A, Breuer M, Keszei A, Stickeler E, Zoremba N, Rossaint R, Bruells C, Meinhold-Heerlein I. The effect of warm and humidified gas insufflation in gynecological laparoscopy on maintenance of body temperature: a prospective randomized controlled multi-arm trial. Arch Gynecol Obstet 2022; 306:753-767. [PMID: 35286431 PMCID: PMC9411231 DOI: 10.1007/s00404-022-06499-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/26/2022] [Indexed: 11/29/2022]
Abstract
Background Hypothermia is defined as a decrease in body core temperature to below 36 °C. If intraoperative heat-preserving measures are omitted, a patient’s temperature will fall by 1 – 2 °C. Even mild forms of intraoperative hypothermia can lead to a marked increase in morbidity and mortality. Using warm and humidified gas insufflation in laparoscopy may help in the maintenance of intraoperative body temperature. Methods In this prospective randomized controlled study, we investigated effects of temperature and humidity of the insufflation gas on intra- and postoperative temperature management. 150 patients undergoing gynecologic laparoscopic surgery were randomly assigned to either insufflation with non-warmed, non-humidified CO2 with forced air warming blanket (AIR), humidified warm gas without forced air warming blanket (HUMI) or humidified warm gas combined with forced air warming blanket (HUMI+). We hypothesized that the use of warmed laparoscopic gas would have benefits in the maintenance of body temperature and reduce the occurrence of hypothermia. Results The use of warm and humidified gas insufflation alone led to more hypothermia episodes with longer duration and longer recovery times as well as significantly lower core body temperature compared to the other two groups. In the comparison of the AIR group and HUMI + group, HUMI + patients had a significantly higher body temperature at arrival at the PACU (Post Anaesthesia Care Unit), had the least occurrence of hypothermia and suffered from less shivering. Conclusion The use of warm and humidified gas insufflation alone does not sufficiently warm the patients. The optimal temperature management is achieved in the combination of external forced air warming and insufflation of warm and humidified laparoscopy gas. Supplementary Information The online version contains supplementary material available at 10.1007/s00404-022-06499-z.
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Affiliation(s)
- Julia Wittenborn
- Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.
| | - Deborah Mathei
- Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Julia van Waesberghe
- Department of Anesthesiology, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Felix Zeppernick
- Department of Gynecology and Obstetrics, University Hospital of Gießen and Marburg, Justus-Liebig University Gießen, Klinikstr. 33, 35392, Giessen, Germany
| | - Magdalena Zeppernick
- Department of Gynecology and Obstetrics, University Hospital of Gießen and Marburg, Justus-Liebig University Gießen, Klinikstr. 33, 35392, Giessen, Germany
| | - Svetlana Tchaikovski
- Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Ana Kowark
- Department of Anesthesiology, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Markus Breuer
- Department of Anesthesiology, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - András Keszei
- Department of Medical Statistics, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Elmar Stickeler
- Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Norbert Zoremba
- Department of Anesthesiology and Intensive Care, St Elisabeth Hospital, Stadtring Kattenstroth 130, 33332, Gütersloh, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Christian Bruells
- Department of Anesthesiology, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Ivo Meinhold-Heerlein
- Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany.,Department of Gynecology and Obstetrics, University Hospital of Gießen and Marburg, Justus-Liebig University Gießen, Klinikstr. 33, 35392, Giessen, Germany
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Breuer M, Wittenborn J, Rossaint R, Van Waesberghe J, Kowark A, Mathei D, Keszei A, Tchaikovski S, Zeppernick M, Zeppernick F, Stickeler E, Zoremba N, Meinhold-Heerlein I, Bruells C. Warm and humidified insufflation gas during gynecologic laparoscopic surgery reduces postoperative pain in predisposed patients-a randomized, controlled multi-arm trial. Surg Endosc 2022; 36:4154-4170. [PMID: 34596747 PMCID: PMC9085687 DOI: 10.1007/s00464-021-08742-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 09/20/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND Postoperative pain remains a common problem in gynecologic laparoscopy, especially in head zone-related regions, triggered by intra-abdominal pressure during capnoperitoneum. Humidified and prewarmed insufflation gas may ameliorate pain and be beneficial. METHODS This prospective randomized controlled parallel group multi-arm single-center study investigated the effects of temperature and humidity of insufflation gas on postoperative pain during gynecologic laparoscopy with a duration ≥ 60 min. Female participants (18-70 years) were blinded and randomly assigned-computer generated-to either insufflation with dry cold CO2 with forced air warming blanket ("AIR"), humidified warm gas without forced air warming blanket ("HUMI"), or humidified warm gas with forced air warming blanket ("HUMI +"). We hypothesized that using humidified warm gas resulted in lower pain scores and less analgesic consumption. The primary endpoint postoperative pain was assessed for different pain localizations every 12 h during 7 days after surgery. Secondary endpoints were demand for painkillers and epidural anesthetics, length of stay in recovery room, and hospital stay. (Registration: ClinicalTrials.gov NCT02781194-completed). RESULTS 150 participants were randomized. Compared to group "AIR" (n = 48), there was significantly less pain in group "HUMI +" (n = 48) in the recovery room (- 1.068; 95% CI - 2.08 to - 0.061), as well as significantly less ibuprofen use at day two (- 0.5871 g ± 0.258; p-value = 0.0471). Other variables did not change significantly. Stratification for presence of endometriosis or non-previous abdominal surgery in patient history revealed significantly less pain in both groups "HUMI" (n = 50) and "HUMI +" versus group "AIR." Related side effects were not noted. CONCLUSION In the overall population, the use of warm, humidified insufflation gas did not yield clinically relevant effects; however, in predisposed patients with endometriosis and who could otherwise expect high pain levels, warm and humidified gas may be beneficial.
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Affiliation(s)
- Markus Breuer
- grid.412301.50000 0000 8653 1507Department of Anesthesiology, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Julia Wittenborn
- grid.412301.50000 0000 8653 1507Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Rolf Rossaint
- grid.412301.50000 0000 8653 1507Department of Anesthesiology, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Julia Van Waesberghe
- grid.412301.50000 0000 8653 1507Department of Anesthesiology, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Ana Kowark
- grid.412301.50000 0000 8653 1507Department of Anesthesiology, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Deborah Mathei
- grid.412301.50000 0000 8653 1507Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - András Keszei
- grid.412301.50000 0000 8653 1507Department of Medical Statistics, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Svetlana Tchaikovski
- grid.412301.50000 0000 8653 1507Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Magdalena Zeppernick
- grid.412301.50000 0000 8653 1507Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany ,grid.8664.c0000 0001 2165 8627Department of Gynecology and Obstetrics, University Hospital of Gießen and Marburg, Justus-Liebig University Gießen, Klinikstr. 33, 35392 Giessen, Germany
| | - Felix Zeppernick
- grid.412301.50000 0000 8653 1507Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany ,grid.8664.c0000 0001 2165 8627Department of Gynecology and Obstetrics, University Hospital of Gießen and Marburg, Justus-Liebig University Gießen, Klinikstr. 33, 35392 Giessen, Germany
| | - Elmar Stickeler
- grid.412301.50000 0000 8653 1507Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - Norbert Zoremba
- grid.416619.d0000 0004 0636 2627Department of Anesthesiology and Intensive Care, St Elisabeth Hospital, Stadtring Kattenstroth 130, 33332 Gütersloh, Germany
| | - Ivo Meinhold-Heerlein
- grid.412301.50000 0000 8653 1507Department of Gynecology and Obstetrics, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany ,grid.8664.c0000 0001 2165 8627Department of Gynecology and Obstetrics, University Hospital of Gießen and Marburg, Justus-Liebig University Gießen, Klinikstr. 33, 35392 Giessen, Germany
| | - Christian Bruells
- grid.412301.50000 0000 8653 1507Department of Anesthesiology, University Hospital of the RWTH Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
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