Examination of intra-operative core temperature in joint arthroplasty: a single-institution prospective observational study
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Peri-operative hypothermia is associated with increased blood loss, delayed wound healing, and surgical site infections. However, it is not known when or how rapidly hypothermia develops during arthroplasty. This study observed patients undergoing lower extremity arthroplasty to identify the times of greatest heat loss or gain.
This single-institution prospective observational study enrolled 120 patients undergoing elective knee or hip arthroplasty for peri-operative temporal temperature measurements at ten prespecified intervals. Incidence of hypothermia was the primary outcome. A secondary aim was to identify patient and operative factors associated with hypothermia. Descriptive statistics were calculated for fixed time variables. Associations for the occurrence of hypothermia over time were conducted using generalized linear mixed models with a logit link and a random subject effect to account for repeated measures on the same individual over time.
Most patients, 72.6%, experienced hypothermia with 20.6% hypothermic for over one hour and 47.1% hypothermic after surgery. In the multivariable model, increased odds of hypothermia were associated with female gender (P = 0.017), knee arthroplasty (P < 0.001), neuraxial anaesthesia (P < 0.001), lower patient pre-operative temperature (P < 0.001), and lower operating room temperature (P = 0.042). A 0.5 °C decrease in patient pre-operative temperature or operating room temperature was associated with a 97 and 11% increase in the odds of hypothermia, respectively, controlling for other factors.
In our series, peri-operative hypothermia remains common for patients undergoing arthroplasty. Female gender, low pre-operative temperature, knee arthroplasty, and neuraxial anesthesia were associated with hypothermia. Further preventative strategies and studies on interventions to reduce hypothermia are needed.
KeywordsTotal joint arthroplasty Hypothermia Intra-operative care Temperature regulation Hypothermia prevention Neuraxial anesthesia
Financial support was provided by The Department of Anesthesia and Perioperative Medicine at the Medical University of South Carolina.
Compliance with ethical standards
Informed consent was obtained from all individual participants included in the study. All procedures were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Conflict of interest
The authors declare that they have no conflict of interest.
- 12.Centers for Medicare & Medicaid Services (2016) Comprehensive care for joint replacement model, https://innovation.cms.gov/initiatives/CJR. Accessed 09 July 2017
- 14.World Health Organization (2009) WHO guidelines for safe surgery 2009: safe surgery saves lives. World Health Organization, Geneva ISBN-13:978-92-4-159855-2Google Scholar
- 23.Calonder EM, Sendelbach S, Hodges JS, Gustafson C, Machemer C, Johnson D, Reiland L (2010) Temperature measurement in patients undergoing colorectal surgery and gynecology surgery: a comparison of esophageal core, temporal artery, and oral methods. J Perianesth Nurs 25:71–78. https://doi.org/10.1016/j.jopan.2010.01.006 CrossRefPubMedGoogle Scholar