He Xu1,2, Zijing Wang1,2, Xin Guan1,2, Yijuan Lu1,2, Daniel Charles Malone3, Jack Warren Salmon4, Aixia Ma5,6, Wenxi Tang7,8. 1. School of International Pharmaceutical Business, China Pharmaceutical University, No.639 Longmian Street, Jiangning District, Nanjing, 211198, China. 2. Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, No.639 Longmian Street, Jiangning District, Nanjing, 211198, China. 3. College of Pharmacy, University of Utah, Salt Lake City, UT, 84101, USA. 4. College of Pharmacy, University of Illinois Chicago, 833 South Wood Street, Chicago, IL, 60612, USA. 5. School of International Pharmaceutical Business, China Pharmaceutical University, No.639 Longmian Street, Jiangning District, Nanjing, 211198, China. aixiama73@126.com. 6. Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, No.639 Longmian Street, Jiangning District, Nanjing, 211198, China. aixiama73@126.com. 7. School of International Pharmaceutical Business, China Pharmaceutical University, No.639 Longmian Street, Jiangning District, Nanjing, 211198, China. tokammy@cpu.edu.cn. 8. Center for Pharmacoeconomics and Outcomes Research, China Pharmaceutical University, No.639 Longmian Street, Jiangning District, Nanjing, 211198, China. tokammy@cpu.edu.cn.
Abstract
BACKGROUND: Previous studies have shown that intraoperative hypothermia was associated with higher risks of clinical adverse events, but we found otherwise from recent evidences. This study aims to synthesize the existing evidence evaluating safety of intraoperative hypothermia. METHODS: Articles, reviews, ongoing trials and grey literatures were retrieved from PubMed, The Cochrane Library, Clinical Trails and CNKI (a Chinese national database) till February 2nd, 2019. Both randomized controlled trials and observational studies compared incidences of all sorts of intra- and post-operative consequences between hypothermia and normothermia were included. Researches comparing different warming systems were excluded. We also examined risks of hypothermia using lowered standards (35.5 °C and 35 °C) from a Chinese trial (ChiCTR-IPR-17011099). RESULTS: A total of 9 RCT studies and 11 observational studies were included. RCT-synthesized results showed that intraoperative hypothermia was associated with higher risks of bleeding (MD = 131.90, 95%CI: 117.42, 146.38), surgical site infection (RD = 0.14, 95%CI: 0.06, 0.21) and shivering (RD = 0.32, 95%CI: 0.06, 0.58) but with no significant differences in duration of surgery, hospital stay or mortality. Observational study-synthesized evidences showed that intraoperative hypothermia did not result in higher risks in any of these adverse events. Results didn't change even if the standard of hypothermia was lowered by 0.5-1.0 °C. CONCLUSIONS: The study indicates that the synthesized risks resulted by intra-operative hypothermia might be overestimated and the eligibility of 36 °C to define hypothermia is not sensitive enough. Given body-temperature protection has not been popularized in China, it is still critical to normalize the hypothermia prevention at this stage.
BACKGROUND: Previous studies have shown that intraoperative hypothermia was associated with higher risks of clinical adverse events, but we found otherwise from recent evidences. This study aims to synthesize the existing evidence evaluating safety of intraoperative hypothermia. METHODS: Articles, reviews, ongoing trials and grey literatures were retrieved from PubMed, The Cochrane Library, Clinical Trails and CNKI (a Chinese national database) till February 2nd, 2019. Both randomized controlled trials and observational studies compared incidences of all sorts of intra- and post-operative consequences between hypothermia and normothermia were included. Researches comparing different warming systems were excluded. We also examined risks of hypothermia using lowered standards (35.5 °C and 35 °C) from a Chinese trial (ChiCTR-IPR-17011099). RESULTS: A total of 9 RCT studies and 11 observational studies were included. RCT-synthesized results showed that intraoperative hypothermia was associated with higher risks of bleeding (MD = 131.90, 95%CI: 117.42, 146.38), surgical site infection (RD = 0.14, 95%CI: 0.06, 0.21) and shivering (RD = 0.32, 95%CI: 0.06, 0.58) but with no significant differences in duration of surgery, hospital stay or mortality. Observational study-synthesized evidences showed that intraoperative hypothermia did not result in higher risks in any of these adverse events. Results didn't change even if the standard of hypothermia was lowered by 0.5-1.0 °C. CONCLUSIONS: The study indicates that the synthesized risks resulted by intra-operative hypothermia might be overestimated and the eligibility of 36 °C to define hypothermia is not sensitive enough. Given body-temperature protection has not been popularized in China, it is still critical to normalize the hypothermia prevention at this stage.
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