Hypothermia and hyperthermia in the ambulatory surgical patient

Office-based Plastic Surgery-Evidence-based Clinical and Administrative Guidelines

Outpatient procedures are extremely prevalent in plastic surgery, with an estimated 82% of cosmetic plastic surgery occurring in this setting. Given that patient safety is paramount, this practical review summarizes major contemporary, evidence-based recommendations regarding office-based plastic surgery. These recommendations not only outline clinical aspects of patient safety guidelines, but administrative, as well, which in combination will provide the reader/practice with a structure and culture that is conducive to the commitment to patient safety. Proper protocols to address potential issues and emergencies that can arise in office-based surgery, and staff familiarity with thereof, are also necessary to be best prepared for such situations.

Nurse Anesthetists' and Operating Theater Nurses' Experiences with Inadvertent Hypothermia in Clinical Perioperative Nursing Care

PURPOSE

To deepen the understanding of and describe nurse anesthetists' and operating theater nurses' experiences with inadvertent hypothermia in clinical perioperative nursing care.

DESIGN

Qualitative, explorative, and descriptive study that carries an inductive nature.

METHODS

Focus group interviews with 16 nurse anesthetists and operating theater nurses from four hospitals in Norway. Gadamer's hermeneutics has guided the study's interpretation.

FINDINGS

Taking the temperature and measures against inadvertent hypothermia perioperatively are not always systematically implemented. In the data material, three thematic units emerged: routines and habits, the culture of the perioperative unit, and silent suffering.

CONCLUSIONS

Complications caused by inadvertent hypothermia in surgical patients can lead to unnecessary suffering and prolong the hospital stay. The surgical team's cooperation and responsibility are linked to routine nursing interventions. These depend on the nurses' knowledge and experience as well as their clinical and subjective assessment of the patient's physical condition and the surgical techniques used.

American Association for Accreditation of Ambulatory Surgical Facilities (AAAASF) History: Its Role in Plastic Surgery Safety

From its origin cosmetic surgery was performed in facilities which were neither certified nor regulated. Recognizing that there was no formal oversight of facilities, a group of plastic surgeons saw the need to develop an accreditation program. This eventually evolved into the American Association for Accreditation of Ambulatory Plastic Surgery Facilities. The organization was started to implement and maintain a voluntary inspection accreditation program for qualifying surgical facilities. Its focus was to educate plastic surgeons on safety and became recognized as the gold standard for accreditation. Seeing the need for similar standards for all surgeons, it morphed into the American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF). Comprehending that accreditation was in everyone’s best interest, AAAASF developed educational formats for plastic surgeons, testified at the US Congress suggesting potential ways that oversight of facilities could improve patient safety, functioned as a resource to numerous states in developing guidelines for oversight of facilities, continued to update its standards, and extended its accreditation program internationally. Recognizing the value of accreditation, proven by AAAAASF’s extensive database from its Internet-Based Quality Assurance Program, the American Society for Aesthetic Plastic Surgery (ASAPS) and the American Society of Plastic Surgeons (ASPS) mandated that its members operate only in accredited or licensed facilities. Numerous studies documenting the safety of accredited plastic surgical facilities from AAAASF’s extensive quality assurance and peer-review reporting program are cited. AAAASF played a significant role and will continue to do that in producing better, safer environments for outpatient surgical procedures.

Effects of Thermal Protection in Patients Undergoing Body Contouring Procedures: A Controlled Clinical Trial

BACKGROUND

Hypothermia is common in many plastic surgery procedures, but few measures to prevent its occurrence are taken.

OBJECTIVES

This study evaluated the effect of hypothermia in patients undergoing plastic surgery procedures and the effect of utilizing simple and inexpensive measures to prevent patient hypothermia during surgery.

METHODS

A randomized controlled clinical trial was performed among 3 groups of patients who underwent body contouring surgery for longer than 3.5 hours. In group 1, no protective measures were taken to prevent hypothermia; in group 2, maneuvers were applied intraoperatively for the duration of the entire surgical procedure; and in group 3, measures were taken preoperatively and intraoperatively. The results were quantified and analyzed through a bivariate analysis, including degree of hypothermia, anesthesia recovery time, time spent in the recovery area, intensity of pain, cold perception, response to opioids, and nausea.

RESULTS

There were 122 patients included in the study: 43 in group 1, 39 in group 2, and 40 in group 3. All patients in group 1 had a higher degree of hypothermia, longer recovery time from anesthesia, longer overall recovery time, increased pain, increased feeling of cold, and more nausea. These patients also required a greater amount of opioids compared with the patients in groups 2 and 3. Many of the results were statistically significant.

CONCLUSIONS

The adoption of simple and inexpensive measures before and during plastic surgery can prevent patient hypothermia during the procedures, leading to a shorter anesthesia recovery time and avoiding the undesirable effects associated with hypothermia. In addition, these measures may have significant economic savings.

LEVEL OF EVIDENCE 2

Guideline Implementation: Preventing Hypothermia

The updated AORN "Guideline for prevention of unplanned patient hypothermia" provides guidance for identifying factors associated with intraoperative hypothermia, preventing hypothermia, educating perioperative personnel on this topic, and developing relevant policies and procedures. This article focuses on key points of the guideline, which addresses performing a preoperative assessment for factors that may contribute to hypothermia, measuring and monitoring the patient's temperature in all phases of perioperative care, and implementing interventions to prevent hypothermia. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.

The impact of perioperative hypothermia on plastic surgery outcomes: a multivariate logistic regression of 1062 cases

BACKGROUND

Perioperative hypothermia has been associated with increased rates of infection, prolonged recovery time, and coagulopathy.

OBJECTIVES

The authors assessed the impact of hypothermia on patient outcomes after plastic surgery and analyzed the impact of prewarming on postoperative outcomes.

METHODS

The medical charts of 1062 patients who underwent complex plastic surgery typically lasting at least 1 hour were reviewed. Hypothermia was defined as a temperature at or below 36°C. Postoperative complication data were collected for outcomes including infection, delayed wound healing, seroma, hematoma, dehiscence, deep venous thrombosis, and overall wound problems. Odds ratios (ORs) were estimated from 3 multivariate logistic regression models of hypothermia and one model of body contouring procedures that included prewarming as a parameter.

RESULTS

Perioperative hypothermia was not a significant predictor of wound problems (OR = 0.83; P = .28). In the stratified regression model, hypothermia did not significantly impact wound problems. The regression model measuring the interaction between hypothermia and operating time did not show a significantly increased risk of wound problems. Prewarming did not significantly affect perioperative hypothermia (P = .510), and in the model of body contouring procedures with prewarming as a categorical variable, massive weight loss was the most significant predictor of wound complications (OR = 2.57; P = .003). Prewarming did not significantly affect outcomes (OR = 1.49; P = .212).

CONCLUSIONS

Based on univariate and multivariate models in our study, mild perioperative hypothermia appears to be independent of wound complications. LEVEL OF EVIDENCE 4: Risk.