Oct 28, 2015

Unintended Hypothermia: Do You Know the Risks?

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Unintended hypothermia remains a common—but easily preventable—complication of surgery.1 It is estimated that unintended hypothermia, defined as a core body temperature of less than 36.0°C (96.8°F), occurs in more than 50% of all US surgical patients, even those undergoing short procedures (one to one-and-a-half hours).2

Numerous studies have demonstrated that even mild perioperative hypothermia can result in significant complications. Unfortunately, temperature management of surgical patients remains a secondary consideration in many O.R.s rather than an essential standard of care.

The list of potential complications associated with unintended hypothermia is extensive. Studies of the impact of hypothermia on the incidence of wound infection have shown that the hypothermic patient is at an appreciably greater risk for wound infection than a normothermic patient.Research also demonstrates that surgical patients with cardiovascular disease who are hypothermic are three times more likely to have adverse myocardial outcomes than normothermic patients.4

Hypothermia alters the effects of many classes of drugs, including muscle relaxants and intravenous anesthetic agents. By decreasing drug metabolism, even mild hypothermia can lead to delayed awakening and require a longer PACU stay.5,6

Increased surgical bleeding has been attributed to hypothermia. In a study of hip arthroplasty patients, a decrease of 1.6°C (2.9°F) in body temperature increased blood loss and the need for allogeneic blood transfusions.7

Hypothermia has also been linked to increased mortality8, pressure ulcer development9 and increased length of hospital stay for surgical patients.1,4

There is also a significant financial benefit of reducing hypothermia rates in surgical patients. Studies have demonstrated that maintaining normothermia can result in savings of $2,500 to $7,000 per patient by eliminating the costs of hypothermia-related complications, including surgical site infections.10

The benefits—to patients, clinicians and facilities—of temperature management are clear. For more information about warming options and to find education materials, click here.

Read Target Normothermia: A Global Focus on Inadvertent Hypothermia

References
  1. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med 1996;334:1209–1215.
  2. Young VL, Watson ME. Prevention of Perioperative Hypothermia in Plastic Surgery. Aesthetic Surgery Journal. 2006;26(5):551-571.
  3. Flores-Maldonado A, Medina-Escobedo CE. Mild perioperative hypothermia and the risk of wound infection. Arch Med Res. 2001;32(3):227-231.
  4. Frank SM, Fleisher LA, Breslow MJ, et al. Perioperative maintenance of normothermia reduces the incidence of morbid cardiac events. A randomized clinical trial. JAMA. 1997;277(14):1127–1134.
  5. Bissonnette B, Sessler DI. Mild hypothermia does not impair postanesthetic recovery in infants and children. Anesth Analg. 1993;76(1):168–172.
  6. Lenhardt R, Marker E, Goll V, et al. Mild intraoperative hypothermia prolongs postanesthetic recovery. Anesthesiology. 1997;87(6):1318–1323.
  7. Schmied H, Kurz A, Sessler DI, Kozek S, Reiter A. Mild hypothermia increases blood loss and transfusion requirements during total hip arthroplasty. Lancet. 1996;347(8997):289–292.
  8. Barie, PS., Surgical Site Infections: Epidemiology and Prevention. Surgical Infections. Vol 3, Supplement 2002; S-9 – S-21.
  9. Scott EM, Buckland R. A systematic review of intraoperative warming to prevent postoperative complications. AORN J. 2006;83(5):1090–1104, 1107-1113.
  10. Mahoney, CB. Odom, J. Maintaining intraoperative normothermia: A meta-analysis of outcomes with costs. AANA Journal. 67(2): 155-164. 1999.

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