Intraoperative hypothermia and its clinical outcomes in patients undergoing general anesthesia: National study in China

Abstract

Background/ObjectiveInadvertent intraoperative hypothermia (core temperature <36°C) is a frequently preventable complication with several adverse consequences. Our study aimed to determine the overall incidence of inadvertent intraoperative hypothermia and its risk factors associated with clinical outcomes in this national survey in China.MethodsWe conducted a national cross-sectional study with 30 days postoperative follow-up from November 2014 through August 2015. A total of 3132 eligible patients underwent general anesthesia were randomly selected from 28 hospitals in the nationwide of China.ResultsThe overall incidence of intraoperative hypothermia was as high as 44.3%, in which cumulative incidence rates of hypothermia being 17.8%, 36.2%, 42.5% and 44.1% within 1 h, 2 h, 3 h and 4 h respectively following induction of anesthesia. All patients were warmed passively by covering of surgical draping, sheets or cotton blankets, whereas only 14.2% of patients received active warming with space heaters or electric heater or electronic blankets. Compared to normothermic patients, patients with hypothermia is associated with more postoperative ICU admit, longer PACU and more postoperative hospital days, but no difference in surgical site infection (SSI) rates or 30-day mortality. Several factors were shown to be associated with decreased risk of hypothermia. They are active warming (OR = 0.46, 95% CI 0.26–0.81), BMI ≥ 25 (OR = 0.54, 95% CI 0.45–0.65), higher baseline core temperature (OR = 0.04, 95% CI 0.03–0.06), and higher ambient temperature (OR = 0.83, 95% CI 0.78–0.88). Risk factors associated with an increased risk of hypothermia included major-plus surgery (OR = 1.49, 95% CI 1.23–1.79), and long anesthesia (>2 h) (OR = 2.60, 95% CI 2.09–3.24).ConclusionsThe incidence of intraoperative hypothermia in China is high, and the rate of active warming of patients during operation is low. Hypothermia is associated with more postoperative shivering, increased ICU admissions, and longer postoperative hospital days.

Impact of Intraoperative Hypothermia on Microsurgical Free Flap Reconstructions

“…This reinforces findings of studies across several surgical disciplines which describe an extended recovery time and prolonged hospitalization and associated costs for hypothermic patients. [39][40][41] Hart et al and Dimick et al estimated that an increase of hospitalization over 4 days, due to complications associated with hypothermia, results in an increased attributable cost of U.S. $8,000 to 25,000 per patient. 39,42 In times of rising economic pressure in health care, this further stresses the importance of maintaining intraoperative normothermia.…”

Beneficial effect of fluid warming in elderly patients with bladder cancer undergoing Da Vinci robotic-assisted laparoscopic radical cystectomy

“…Yi et al conducted a national cross-sectional study in China on 3,132 patients under general anesthesia, and the results demonstrate that intraoperative hypothermia would increase intensive care unit (ICU) admissions and prolonged hospitalization days (23). Kurz et al have demonstrated that maintaining normothermia intraoperatively by combining intravenous fluids warming and forced-air cover can effectively decrease the incidence of infectious complications and hospitalization days (15).…”

Establishment and Validation of a Prediction Equation to Estimate Risk of Intraoperative Hypothermia in Patients Receiving General Anesthesia

“…For example, the Surgical Care Improvement Project suggested a final intraoperative temperature above 36 °C and use of active over-body warming for body temperature below 36 °C 20 . In the United States, according to guidelines 22 , all surgical patients are actively warmed. And active warming is suggested but is uncommon in many other developed Western countries 21 .…”