Effect of Perioperative Active Body Surface Warming Systems on Analgesic and Clinical Outcomes: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Abstract

BACKGROUND: Inadvertent perioperative hypothermia is a common complication of surgery, and active body surface warming (ABSW) systems are used to prevent adverse clinical outcomes. Prior data on certain outcomes are equivocal (ie, blood loss) or limited (ie, pain and opioid consumption). The objective of this study was to provide an updated review on the effect of ABSW on clinical outcomes and temperature maintenance. METHODS: We conducted a systematic review of randomized controlled trials evaluating ABSW systems compared to nonactive warming controls in noncardiac surgeries. Outcomes studied included postoperative pain scores and opioid consumption (primary outcomes) and other perioperative clinical variables such as temperature changes, blood loss, and wound infection (secondary outcomes). We searched Ovid MEDLINE daily, Ovid MEDLINE, EMBASE, CINHAL, Cochrane CENTRAL, and Web of Science from inception to June 2019. Quality of evidence (QoE) was rated according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. Subgroup analysis sought to determine the effect of preoperative + intraoperative warming versus intraoperative warming alone. Metaregression evaluated the effect of year of publication, use of neuromuscular blockers, anesthesia, and surgery type on outcomes. RESULTS: Fifty-four articles (3976 patients) were included. Pooled results demonstrated that ABSW maintained normothermia compared to controls, during surgery (30 minutes postinduction [mean difference {MD}: 0.3°C, 95% confidence interval {CI}, 0.2–0.4, moderate QoE]), end of surgery (MD: 1.1°C, 95% CI, 0.9–1.3, high QoE), and up to 4 hours postoperatively (MD: 0.3°C, 95% CI, 0.2–0.5, high QoE). ABSW was not associated with difference in pain scores (<24 hours postoperatively, moderate to low QoE) or perioperative opioid consumption (very low QoE). ABSW increased patient satisfaction (MD: 2.2 points, 95% CI, 0.9–3.6, moderate QoE), reduced blood transfusions (odds ratio [OR] = 0.6, 95% CI, 0.4–1.0, moderate QoE), shivering (OR = 0.2, 95% CI, 0.1–0.4, high QoE), and wound infections (OR = 0.3, 95% CI, 0.2–0.7, high QoE). No significant differences were found for fluid administration (low QoE), blood loss (very low QoE), major adverse cardiovascular events (very low QoE), or mortality (very low QoE). Subgroup analysis and metaregression suggested increased temperature benefit with pre + intraoperative warming, use of neuromuscular blockers, and recent publication year. ABSW seemed to confer less temperature benefit in cesarean deliveries and neurosurgical/spinal cases compared to abdominal surgeries. CONCLUSIONS: ABSW is effective in maintaining physiological normothermia, decreasing wound infections, shivering, blood transfusions, and increasing patient satisfaction but does not appear to affect postoperative pain and opioid use.

Perioperative Hypothermia—A Narrative Review

“…This is important, especially in orthopaedic surgery, where lesions of small osseous vessels that cannot be coagulated mainly contribute to perioperative blood loss [67]. Active body-surface warming and maintenance of normothermia can reduce blood transfusions (odds ratio 0.6) in non-cardiac surgery [68].…”

“…Hypothermia-associated surgical site infections may increase the length and overall cost of the postoperative in-hospital stay [74]. A recent metanalysis found that active body-surface warming reduces wound infections with an odds ratio of 0.3 (95% CI, 0.2-0.7) after non-cardiac surgery [68]. Perioperative hypothermia affects the immune system, and consequently the host defence against pathogens, in various ways.…”

Inadvertent hypothermia after endovascular therapy is not associated with improved outcome in stroke due to anterior circulation large vessel occlusion

“…The occurrence of inadvertent perioperative hypothermia is well known in surgery, where it is associated with increased complication rates (e.g., wound infections, shivering, need for blood transfusions, and cardiovascular complications) [22,23]. In the randomized SIESTA trial, temperature disturbances (i.e., hyperthermia of >37.2°C or hypothermia of <36°C) were associated with performance of EVT under general anesthesia [12].…”

Zero-Heat-Flux and Esophageal Temperature Monitoring in Orthopedic Surgery: An Observational Study

“…2 Core temperature is tightly regulated, and even mild perioperative hypothermia is associated with adverse consequences. [3][4][5][6][7][8][9] The lack of accurate, user-friendly temperature monitoring devices is a known barrier to optimum thermoregulation practices across the multidisciplinary perioperative pathway. 10,11 International guidelines specify that temperature measurement is conducted at specific, regular intervals, using a consistent device.…”