Jennifer R Matos1, Julie R McSwain1, Bethany J Wolf2, J Wesley Doty1, Sylvia H Wilson3. 1. Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 167 Ashley Avenue, Suite 301, MSC 912, Charleston, SC, 29425-9120, USA. 2. Department of Public Health Sciences, Medical University of South Carolina, 302B 135 Cannon St., Charleston, SC, 29425-9120, USA. 3. Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina, 167 Ashley Avenue, Suite 301, MSC 912, Charleston, SC, 29425-9120, USA. wilsosh@musc.edu.
Abstract
PURPOSE: Peri-operative hypothermia is associated with increased blood loss, delayed wound healing, and surgical site infections. However, it is not known when or how rapidly hypothermia develops during arthroplasty. This study observed patients undergoing lower extremity arthroplasty to identify the times of greatest heat loss or gain. METHODS: This single-institution prospective observational study enrolled 120 patients undergoing elective knee or hip arthroplasty for peri-operative temporal temperature measurements at ten prespecified intervals. Incidence of hypothermia was the primary outcome. A secondary aim was to identify patient and operative factors associated with hypothermia. Descriptive statistics were calculated for fixed time variables. Associations for the occurrence of hypothermia over time were conducted using generalized linear mixed models with a logit link and a random subject effect to account for repeated measures on the same individual over time. RESULTS: Most patients, 72.6%, experienced hypothermia with 20.6% hypothermic for over one hour and 47.1% hypothermic after surgery. In the multivariable model, increased odds of hypothermia were associated with female gender (P = 0.017), knee arthroplasty (P < 0.001), neuraxial anaesthesia (P < 0.001), lower patient pre-operative temperature (P < 0.001), and lower operating room temperature (P = 0.042). A 0.5 °C decrease in patient pre-operative temperature or operating room temperature was associated with a 97 and 11% increase in the odds of hypothermia, respectively, controlling for other factors. CONCLUSION: In our series, peri-operative hypothermia remains common for patients undergoing arthroplasty. Female gender, low pre-operative temperature, knee arthroplasty, and neuraxial anesthesia were associated with hypothermia. Further preventative strategies and studies on interventions to reduce hypothermia are needed.
PURPOSE: Peri-operative hypothermia is associated with increased blood loss, delayed wound healing, and surgical site infections. However, it is not known when or how rapidly hypothermia develops during arthroplasty. This study observed patients undergoing lower extremity arthroplasty to identify the times of greatest heat loss or gain. METHODS: This single-institution prospective observational study enrolled 120 patients undergoing elective knee or hip arthroplasty for peri-operative temporal temperature measurements at ten prespecified intervals. Incidence of hypothermia was the primary outcome. A secondary aim was to identify patient and operative factors associated with hypothermia. Descriptive statistics were calculated for fixed time variables. Associations for the occurrence of hypothermia over time were conducted using generalized linear mixed models with a logit link and a random subject effect to account for repeated measures on the same individual over time. RESULTS: Most patients, 72.6%, experienced hypothermia with 20.6% hypothermic for over one hour and 47.1% hypothermic after surgery. In the multivariable model, increased odds of hypothermia were associated with female gender (P = 0.017), knee arthroplasty (P < 0.001), neuraxial anaesthesia (P < 0.001), lower patient pre-operative temperature (P < 0.001), and lower operating room temperature (P = 0.042). A 0.5 °C decrease in patient pre-operative temperature or operating room temperature was associated with a 97 and 11% increase in the odds of hypothermia, respectively, controlling for other factors. CONCLUSION: In our series, peri-operative hypothermia remains common for patients undergoing arthroplasty. Female gender, low pre-operative temperature, knee arthroplasty, and neuraxial anesthesia were associated with hypothermia. Further preventative strategies and studies on interventions to reduce hypothermia are needed.
Entities:
Keywords:
Hypothermia; Hypothermia prevention; Intra-operative care; Neuraxial anesthesia; Temperature regulation; Total joint arthroplasty
Authors: Lynn B Barringer; Cheryl W Evans; Lori L Ingram; Patrice P Tisdale; Susan P Watson; Janice K Janken Journal: J Perianesth Nurs Date: 2011-06 Impact factor: 1.084