Is Perioperative Hypothermia a Risk Factor for Post-Cesarean Infection?

OBJECTIVE To determine whether hypothermia during Cesarean delivery is a risk factor for postoperative infection. METHODS An historical cohort investigation was conducted on all women delivered by Cesarean at our center during 2001. Initial recovery-room temperature, taken via the oral or axillary route, was used as a surrogate for intraoperative temperature. Adding 0.5 degrees C to axillary temperatures generated oral temperature equivalents. Women with chorioamnionitis were excluded, as were those with an initial recovery-room temperature that exceeded 37.9 degrees C or was recorded more than 20 minutes after the end of surgery. Prophylactic antibiotics (cefazolin, 1 g) were given during Cesarean delivery. RESULTS A total of 42 women (7.6%) were diagnosed with postoperative infections. Infections included endometritis (n = 25), wound abscess (n = 7), wound cellulitis (n = 7) and urinary tract infection (UTI) (n = 4). No cases of septic pelvic thrombophlebitis or pelvic abscess occurred. One woman had both endometritis and a UTI. Mean temperatures were higher, rather than lower, for women who subsequently had postoperative infections compared with those who did not (36.4 +/- 0.8 degrees C vs. 35.9 +/- 0.7 degrees C; p < 0.001). Mean temperatures for the various postoperative infections were as follows: endometritis, 36.5 +/- 0.8 degrees C (p < 0.001 vs. uninfected group); wound abscess 36.0 +/- 0.8 degrees C (p = 0.63); wound cellulitis, 36.3 +/- 0.6 degrees C (p = 0.14); UTI, 36.7 +/- 0.9 degrees C (p = 0.04). CONCLUSIONS Women who develop post-Cesarean infections have higher initial recovery-room temperatures than those who do not develop such infections. This suggests the presence of subclinical infection at the time of Cesarean. Evaluating whether intraoperative warming has any role during Cesarean delivery requires a randomized clinical trial.