Continuous perioperative warming to reduce incidence of inadvertent perioperative hypothermia in joint replacement patients

Abstract

Introduction: Inadvertent perioperative hypothermia (IPH) with core temperature below 36°C is not uncommon because of the thermal redistribution during anaesthesia. It is associated with surgical site infection, bleeding, and postoperative pain. A recent survey showed the local incidence of IPH was 38.9%. Evidence from literature review suggested actively prewarming for 20 to 30 minutes before operations is an effective way to reduce the prevalence of IPH. The aim of the study was to identify if preoperative warming 20 to 30 minutes before anaesthesia could maintain a body temperature above 36°C upon arrival to post-anaesthesia care unit (PACU) for patients undergoing total joint replacement (TJR). Methods: A retrospective analysis was performed to evaluate the effectiveness of prewarming on hypothermia in TJR patients. Patients were actively prewarmed by forced air device for at least 20 minutes before surgery. The on-arrival tympanic temperature in PACU was compared between two periods: before implementation (conventional group: March 2018-May 2018) and after implementation (prewarming group: June 2018-August 2018). Results: A total of 114 patients undergoing TJR were included. A total of 61 patients were in the conventional group and 53 patients were in the prewarming group. There was statistically significant difference in the incidence of IPH (conventional group: 24.6%; prewarming group: 9.4%, p=0.034). Conclusion: The above results suggested that preoperative warming reduces the incidence of IPH in joint replacement patients.