Ziolkowski N, et al. - The associations between hypothermia and operative time on post-operative complications in acute burn surgery were assessed. Patients more likely to develop complications were who underwent prolonged surgeries and become hypothermic. Therefore, the authors advocated for diligent adherence to strategies to prevent hypothermia. They also recommended limiting operative time in clinical circumstances where intraoperative measures were unlikely to adequately prevent hypothermia.

• From January 1, 2006, to October 31, 2015, the authors completed a historical cohort study at an American Burn Association verified burn centre.
• They included 1,111 consecutive patients undergoing acute burn surgery and analyzed 2,171 surgeries.
• Post-operative complications, defined a priori as either infectious or noninfectious were included as primary outcomes.
• They undertook statistical analysis using a modified Poisson model for relative risk, adjusted for total body surface area, inhalation injury, co-morbidities, substance abuse, and age.

• The mean operative time was 4.4 h (SD 3.7-4.7 h; range 0.58-11 h).
• In this study, 18.6% of patients became hypothermic intra-operatively.
• Factors independently associated with operative time were the incidence of hypothermia (p < 0.05), and both infectious (RR1.5; 1.2-1.9, p < 0.0004) and non-infectious complications (RR2.3; 1.3-4.1, p < 0.0066).
• Hypothermia predisposed to infectious (RR1.3; 1.1-1.5, p < 0.0017) and non-infectious complications (RR1.7; 1.2-2.5; p < 0.0049) in patients with major burns (TBSA ≥ 20%).
• Risk stratification demonstrated that when compared with those without these risk factors, hypothermic patients with major burns undergoing prolonged surgery had an increased risk of both infectious (RR1.4; 1.1-1.7, p < 0.0068) and non-infectious complications (RR1.8; 1.1-3.0, p < 0.0132).