Hypothermia and complications in postbariatric body contouring

Background: Postbariatric body contouring represents a rapidly growing field. With long operative times and high rates of minor complications, evidence-based guidelines for operative management are needed. Data analyzing the impact of perioperative factors on patient outcomes are currently limited. Methods: Patients who lost 50 pounds or more and underwent body contouring were enrolled in an institutional review board-approved prospective registry over 4 years. All cases were performed by the senior author at two community hospitals and two academic hospitals. Hypothermia was defined as a minimum temperature of 35°C or lower. Results: Three hundred eight patients (272 women and 36 men) were analyzed. The average operative time was 4.7 hours, and 71.4 percent of cases were performed in an academic hospital. The average minimum operative temperature was 35.6 ± 0.63°C (range, 34.0 to 38.0°C), and the average maximum operative temperature was 36.5 ± 0.75°C (range, 34.8 to 39.0°C). On multivariate analysis, a lower minimum temperature was associated with both seroma (p = 0.003; odds ratio, 3.1 per 1°C decrease) and transfusion (p = 0.005; odds ratio, 2.4 per 1°C decrease). Conclusions: Operative hypothermia was present in one-fifth of cases. Lower intraoperative temperature was associated with an increased risk of seroma formation, blood loss, and the need for transfusion. Despite this, there were few major complications in lengthy cases involving substantial blood loss. Maintaining normothermia is a critical component of perioperative management. The authors have adopted a protocol involving patient prewarming, a higher operating room temperature, and the routine use of warmed fluids. Clinical Question/Level of Evidence: Risk, II.