Preoperative Warming Reduces Intraoperative Hypothermia in Total Joint Arthroplasty Patients

Abstract

Introduction: Perioperative hypothermia (PH) is common in patients undergoing total joint arthroplasty (TJA). A previous study at our institution identified the largest drop in core body temperature between preoperative holding and induction of anesthesia. This study evaluates the effect of preoperative warming measures on PH in TJA patients. Methods: A retrospective review was conducted of 672 patients undergoing TJA at our institution between April 1 and October 31, 2017. Under the new normothermia protocol, patients received warmed intravenous fluids and forced-air warming gowns in the preoperative holding area. Time and temperature data for the perioperative period were collected from the electronic health record. Chi-square and paired t-tests were used to compare between total knee arthroplasty and total hip arthroplasty patients and between new and old protocols. Results: In the new protocol, 173 of 672 (26%) patients were hypothermic at incision compared with 140 of 383 (37%) patients in the previous protocol (P < 0.05). The largest drop in core body temperature occurred between preoperative holding and induction of anesthesia. The duration of time from operating room entry to incision was less for normothermic than for hypothermic patients. The duration of hypothermia was similar between new and old protocols overall, but markedly fewer total hip arthroplasty patients remained hypothermic for the entire surgery under the new protocol. Conclusion: Adding forced-air warming preoperatively to our warming protocol reduced the rate of PH by approximately 30%. The time from entry into the operating room to the start of surgery should be minimized because patients are vulnerable to PH during this interval.

Construction and validation of postoperative hypothermia prediction model for patients undergoing joint replacement surgery

“…Thus, our study suggests the importance of intraoperative hypothermia management and preventive measures. In addition, some researchers recommend active skin warming and heating, timely blood transfusion in patients with excessive blood loss, prophylactic platelet transfusion in patients with low preoperative PLT count to reduce the incidence of hypothermia (Kay et al, 2020b; Liu et al, 2019; Nordgren et al, 2020b).…”

“…Presently, increasingly, medical staff pay attention to the study of perioperative hypothermia, which has gradually become a challenge for postoperative management. Previous studies reported that the risk factors affecting intraoperative hypothermia in patients with joint replacement were complex and changeable, which could be mainly summarised as follows:(1) Patients' factors: elderly women, low BMI and low basal body temperature were high-risk factors for hypothermia (Frisch et al, 2017;Jildeh et al, 2018a;Pu et al, 2022a;; (2) Heat preservation measures: active heat preservation (external heat applied to skin and surrounding tissues, such as forced air heating) could reduce the risk of hypothermia by 29%, when compared with passive heat preservation (helping heat storage and preventing loss, such as blanketing) and the combined application of multiple active heat preservation measures could significantly reduce the incidence of hypothermia (Jun et al, 2019;Kay et al, 2020a;Nordgren et al, 2020a); (3) Anaesthesia duration: for every 1 min increase in anaesthesia duration, the core body temperature of patients decreased by .00298°C (Emmert et al, 2018);…”

“…Presently, increasingly, medical staff pay attention to the study of perioperative hypothermia, which has gradually become a challenge for postoperative management. Previous studies reported that the risk factors affecting intraoperative hypothermia in patients with joint replacement were complex and changeable, which could be mainly summarised as follows:(1) Patients' factors: elderly women, low BMI and low basal body temperature were high‐risk factors for hypothermia (Frisch et al, 2017; Jildeh et al, 2018a; Pu et al, 2022a; Yi & Lei et al, 2017); (2) Heat preservation measures: active heat preservation (external heat applied to skin and surrounding tissues, such as forced air heating) could reduce the risk of hypothermia by 29%, when compared with passive heat preservation (helping heat storage and preventing loss, such as blanketing) and the combined application of multiple active heat preservation measures could significantly reduce the incidence of hypothermia (Jun et al, 2019; Kay et al, 2020a; Nordgren et al, 2020a); (3) Anaesthesia duration: for every 1 min increase in anaesthesia duration, the core body temperature of patients decreased by .00298°C (Emmert et al, 2018); (4) Ambient temperature: low ambient temperature was a risk factor for hypothermia (Pei et al, 2018; Yi & Lei et al, 2017) and (5) Other factors, such as the type of operation, the scale of operation, the amount of intraoperative fluid input and the occurrence of intraoperative hypothermia, all had an impact on the occurrence of hypothermia (Matos et al, 2018; Simpson et al, 2018c; Sun et al, 2021). Based on the above findings, we concluded that most previous studies focused on the analysis of risk factors of intraoperative hypothermia and thermal insulation nursing intervention but paid little attention to the postoperative situation of patients with joint replacement surgery and related early warning measures.…”

The Impact of Intraoperative Hypothermia on Blood Loss and Allogenic Blood Transfusion in Total Knee and Hip Arthroplasty: A Retrospective Study

“…Body temperature has been reported to drop obviously between preoperative holding and induction of anesthesia [12]. A previous study used preoperative forced-air warming and found that it could significantly decrease the rate of intraoperative hypothermia [24].…”

Update on current enhanced recovery after surgery (ERAS) pathways for hip and knee arthroplasty: a review of the literature

“…46,47 However, based on this review of the current literature, the most effective and efficient method of warming is via forced warm air, 42,48 which ideally should begin preoperatively because there can be a large temperature drop between preoperative holding and induction of anesthesia. 42,44 To prevent this drop, a recent study by Kay et al 49 found that forced-air gowns in the preoperative holding area reduced perioperative hypothermia by 30%. Current literature continues to support the maintenance of normothermia perioperatively, with forced-air methods proving the most effective.…”