Intraoperative Hypothermia During Surgical Fixation of Hip Fractures

Abstract

Hip fractures are common orthopedic injuries and are associated with significant morbidity/mortality. Intraoperative normothermia is recommended by national guidelines to minimize additional morbidity/mortality, but limited evidence exists regarding hypothermia's effect on orthopedic patients. The purpose of this study was to determine the incidence of intraoperative hypothermia in patients with operatively treated hip fractures and evaluate its effect on complications and outcomes. Retrospective chart review was performed on clinical records from 1541 consecutive patients who sustained a hip fracture and underwent operative fixation at the authors' institution between January 2005 and October 2013. A total of 1525 patients were included for analysis, excluding those with injuries requiring additional surgical intervention. Patient demographic data, surgery-specific data, postoperative complications, length of stay, and 30-day readmission were recorded. Patients with a mean intraoperative temperature less than 36°C were identified as hypothermic. Statistical analysis with univariate and multivariate logistic regression modeling evaluated associations with hypothermia and effect on complications/outcomes. The incidence of intraoperative hypothermia in operatively treated hip fractures was 17.0%. Hypothermia was associated with an increase in the rate of deep surgical-site infection (odds ratio, 3.30; 95% confidence interval, 1.19-9.14; P=.022). Lower body mass index and increasing age demonstrated increased association with hypothermia (P=.004 and P=.005, respectively). To the authors' knowledge, this is the first and largest study analyzing the effect of intraoperative hypothermia in orthopedic patients. In patients with hip fractures, the study's findings confirm evidence found in other surgical specialties that hypothermia may be associated with an increased risk of deep surgical-site infection and that lower body mass index and increasing age are risk factors for intraoperative hypothermia. [Orthopedics. 2016; 39(6):e1170-e1177.].

Examination of intra-operative core temperature in joint arthroplasty: a single-institution prospective observational study

“…Finally, both female gender and temperature entering the OR were statistically significant with developing hypothermia over time. Other studies have noted several patient factors to be associated with increased rates of peri-operative hypothermia including increased age and female gender [13,18]. These results may suggest that providers should be more aggressive in either preventing or treating hypothermia in females.…”

Inadvertent Perioperative Hypothermia Risks and Postoperative Complications: A Retrospective Study

“…Many patients experience hypothermia during their surgical procedures. Perioperative hypothermia has been documented in patients during various procedures (eg, total hip arthroplasty, colorectal surgeries) with incidence rates ranging from 17.0% to 88.6% depending on the type of surgery …”

Perioperative Risk Factors for Intraoperative Hypothermia in Adult Patients Undergoing Elective Surgery at a National Referral Hospital in Bhutan: A Prospective Observational Study

“…The incidence of intraoperative hypothermia in our study was 61.5% which is quite high compared with other studies. [1][2][3] We predicted a high incidence due to the cold climate and the geographical setting in our country. Duration of anesthesia more than 60 minutes and preoperative heart rate less than 80 beats per minute were statistically significant risk factors for intraoperative hypothermia in our patients.…”

“…The incidence has been reported as high as 30.0 to 50.0%. [1][2][3] Intraoperative hypothermia is associated with complications that include postoperative shivering, intraoperative bleeding, delayed wound healing, wound infection, and anesthetic problems such as delayed awakening from anesthesia. [4][5][6][7][8] Thus, it is important to identify intraoperative hypothermia early to prevent these complications.…”