Colorectal cancer

Background[edit source]

Normal thermoregulation is disrupted during anaesthesia and surgery due to multiple factors.[1] Unintended perioperative hypothermia is common in surgical patients, and has been reported to be associated with platelet dysfunction, bleeding, wound infection, alterations of pharmacotherapeutic effects and shivering.[2]

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Overview of evidence (non-systematic literature review)[edit source]

No systematic reviews were undertaken for this topic. Practice points were based on selected published evidence. See Guidelines development process.

Effects of perioperative body temperature on wound site[edit source]

One randomised controlled trial of 200 patients undergoing colorectal surgery reported that maintenance of a normal body temperature (near 36.5°C) during colorectal surgery using forced-air warming combined with fluid warming decreased the rate of surgical site infectionand reduced length of stay, compared with allowing body temperature to decrease to approximately 34.5°C.[3]

Subsequent observational cohort studies have not always supported the three-fold reduction in surgical site infection seen in the original study.[4][5]

Avoidance of hypothermia should be encouraged for its other benefits, which may include improved wound healing associated with a reduction in hospital stay.[3]

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Strategies for maintaining perioperative body temperature[edit source]

Strategies for maintaining perioperative body temperature include warming intravenous (IV) and irrigation fluids, the use of reflective blankets or clothing, and forced air warming, and prewarming.[6][7]

The use of warmed IV fluids has been shown to be effective in maintaining body temperature in adults.[7] Pre-warming for a minimum of 30 minutes may also reduce the risk of subsequent hypothermia.[6] There is no clear evidence that the use of reflective blankets or clothing increases body temperature, compared with usual care.[7]

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Perioperative normothermia should ideally be maintained at or above 36.0˚C.

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The use of warmed IV fluids and forced-air warming can be used to minimise perioperative hypothermia.

Next section: enhanced recovery after surgery

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References[edit source]

  1. Sessler, DI. Temperature monitoring and perioperative thermoregulation. Anesthesiology ;2008 Aug; 109(2): 318–338.
  2. Joanna Briggs Institute. Strategies for the management and prevention of hypothermia within the adult perioperative environment Best Practice: evidence-based information sheets for health professionals. 2010; 14(13):1-4.;.
  3. 3.0 3.1 Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 1996 May 9;334(19):1209-15 Available from:
  4. Baucom RB, Phillips SE, Ehrenfeld JM, Muldoon RL, Poulose BK, Herline AJ, et al. Association of Perioperative Hypothermia During Colectomy With Surgical Site Infection. JAMA Surg 2015 Jun;150(6):570-5 Available from:
  5. Lehtinen SJ, Onicescu G, Kuhn KM, Cole DJ, Esnaola NF. Normothermia to prevent surgical site infections after gastrointestinal surgery: holy grail or false idol? Ann Surg 2010 Oct;252(4):696-704 Available from:
  6. 6.0 6.1 Hart, SR; Bordes, B; Hart, J; Corsino, D; Harmon, D;. Unintended perioperative hypothermia. The Ochsner Journal ;2011;11(3):259-270.
  7. 7.0 7.1 7.2 National Collaborating Centre for Nursing and Supportive Care. National Institute for Health and Clinical Excellence (commissioner). The management of inadvertent perioperative hypothermia in adults. (NICE CG65). London: National Institute for Health and Clinical Excellence; 2008 Available from:

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