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Xia F, Li Q, Xu L, Chen X, Li G, Li L, Cheng Z, Zhang J, Deng C, Li J, Chen R. Development and validation of an intraoperative hypothermia nomograph model for patients undergoing video-assisted thoracoscopic lobectomy: a retrospective study. Sci Rep 2024; 14:15202. [PMID: 38956148 PMCID: PMC11219828 DOI: 10.1038/s41598-024-66222-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/28/2024] [Indexed: 07/04/2024] Open
Abstract
This study aimed to develop and internally validate a nomogram model for assessing the risk of intraoperative hypothermia in patients undergoing video-assisted thoracoscopic (VATS) lobectomy. This study is a retrospective study. A total of 530 patients who undergoing VATS lobectomy from January 2022 to December 2023 in a tertiary hospital in Wuhan were selected. Patients were divided into hypothermia group (n = 346) and non-hypothermia group (n = 184) according to whether hypothermia occurred during the operation. Lasso regression was used to screen the independent variables. Logistic regression was used to analyze the risk factors of hypothermia during operation, and a nomogram model was established. Bootstrap method was used to internally verify the nomogram model. Receiver operating characteristic (ROC) curve was used to evaluate the discrimination of the model. Calibration curve and Hosmer Lemeshow test were used to evaluate the accuracy of the model. Decision curve analysis (DCA) was used to evaluate the clinical utility of the model. Intraoperative hypothermia occurred in 346 of 530 patients undergoing VATS lobectomy (65.28%). Logistic regression analysis showed that age, serum total bilirubin, inhaled desflurane, anesthesia duration, intraoperative infusion volume, intraoperative blood loss and body mass index were risk factors for intraoperative hypothermia in patients undergoing VATS lobectomy (P < 0.05). The area under ROC curve was 0.757, 95% CI (0.714-0.799). The optimal cutoff value was 0.635, the sensitivity was 0.717, and the specificity was 0.658. These results suggested that the model was well discriminated. Calibration curve has shown that the actual values are generally in agreement with the predicted values. Hosmer-Lemeshow test showed that χ2 = 5.588, P = 0.693, indicating that the model has a good accuracy. The DCA results confirmed that the model had high clinical utility. The nomogram model constructed in this study showed good discrimination, accuracy and clinical utility in predicting patients with intraoperative hypothermia, which can provide reference for medical staff to screen high-risk of intraoperative hypothermia in patients undergoing VATS lobectomy.
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Affiliation(s)
- Fuhai Xia
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Qiang Li
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
| | - Liqin Xu
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Xi Chen
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Gen Li
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Li Li
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Zhineng Cheng
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Jie Zhang
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Chaoliang Deng
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Jing Li
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China
| | - Rui Chen
- Operating Room, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430014, China.
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Cao B, Li Y, Liu Y, Chen X, Liu Y, Li Y, Wu Q, Ji F, Shu H. A multi-center study to predict the risk of intraoperative hypothermia in gynecological surgery patients using preoperative variables. Gynecol Oncol 2024; 185:156-164. [PMID: 38428331 DOI: 10.1016/j.ygyno.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/27/2024] [Accepted: 02/07/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES Hypothermia is highly common in patients undergoing gynecological surgeries under general anesthesia, so the length of hospitalization and even the risk of mortality are substantially increased. Our aim was to develop a simple and practical model to preoperatively identify gynecological surgery patients at risk of intraoperative hypothermia. METHODS In this retrospective study, we collected data from 802 patients who underwent gynecological surgery at three medical centers from June 2022 to August 2023. We further allocated the patients to a training group, an internal validation group, or an external validation group. The preliminary predictive factors for intraoperative hypothermia in gynecological patients were determined using the least absolute shrinkage and selection operator (LASSO) method. The final predictive factors were subsequently identified through multivariate logistic regression analysis, and a nomogram for predicting the occurrence of hypothermia was established. RESULTS A total of 802 patients were included, with 314 patients in the training cohort (mean age 48.5 ± 12.6 years), 130 patients in the internal validation cohort (mean age 49.9 ± 12.5 years), and 358 patients in the external validation cohort (mean age 47.6 ± 14.0 years). LASSO regression and multivariate logistic regression analyses indicated that body mass index, minimally invasive surgery, baseline heart rate, baseline body temperature, history of previous surgery, and aspartate aminotransferase level were associated with intraoperative hypothermia in gynecological surgery patients. This nomogram was constructed based on these six variables, with a C-index of 0.712 for the training cohort. CONCLUSIONS We established a practical predictive model that can be used to preoperatively predict the occurrence of hypothermia in gynecological surgery patients. CLINICAL TRIAL REGISTRATION chictr.org.cn, identifier ChiCTR2300071859.
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Affiliation(s)
- Bingbing Cao
- Department of Anesthesiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, PR China
| | - Yongxing Li
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital of Sun Yat-Sen University, Guangzhou 510120, PR China
| | - Yongjian Liu
- Department of Pain Management, Guangdong Second Provincial General Hospital, Guangzhou 510317, PR China
| | - Xiangnan Chen
- Department of Anesthesiology, Guangdong Women and Children Hospital, Guangzhou 510010, PR China
| | - Yong Liu
- Department of Anesthesiology, Third People's Hospital of Shenzhen, Shenzhen 518112, PR China
| | - Yao Li
- Department of Anesthesiology, Shenshan Medical Center, Memorial Hospital of Sun Yat-Sen University, Shanwei 516601, PR China
| | - Qiang Wu
- Department of Anesthesiology, Third People's Hospital of Shenzhen, Shenzhen 518112, PR China
| | - Fengtao Ji
- Department of Anesthesiology, Sun Yat-sen Memorial Hospital of Sun Yat-Sen University, Guangzhou 510120, PR China.
| | - Haihua Shu
- Department of Anesthesiology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510080, PR China; Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, PR China; School of Medicine, South China University of Technology, Guangzhou 510080, PR China.
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Stuart CM, Dyas AR, Bronsert MR, Abrams BA, Kelleher AD, Colborn KL, Randhawa SK, David EA, Mitchell JD, Meguid RA. Perioperative hypothermia in robotic-assisted thoracic surgery: Incidence, risk factors, and associations with postoperative outcomes. J Thorac Cardiovasc Surg 2024; 167:1979-1989.e1. [PMID: 37865182 PMCID: PMC11034550 DOI: 10.1016/j.jtcvs.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Revised: 09/27/2023] [Accepted: 10/15/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE Inadvertent perioperative hypothermia has been associated with poor surgical outcomes. The purpose of this study was to evaluate the incidence and associated postoperative complications of inadvertent perioperative hypothermia in patients undergoing robotic-assisted thoracic surgery lung resections. METHODS This was a single-center, retrospective cohort study evaluating all consecutive patients who underwent robotic-assisted thoracic surgery lung resection between January 1, 2021, and November 30, 2022. Temperatures were measured at 5 time points: preprocedure unit, anesthesia induction, 30 minutes postinduction, extubation, and recovery room arrival. Temperature changes were calculated at each interval. Adjusted and unadjusted comparison was performed between those who experienced varying levels of inadvertent perioperative hypothermia (Hypothermia I: <36 °C, Hypothermia II: <35.5 °C, and Hypothermia III: <35 °C) and those who did not. RESULTS A total of 313 patients were included, and 201 (64.2%) lobectomies, 50 (16.0%) segmentectomies, and 62 (19.8%) wedge resections were performed. Across all patients, 291 (93.0%) had a temperature less than 36 °C, 195 (62.3%) had a temperature less than 35.5 °C, and 100 (31.9%) had a temperature less than 35.0 °C. Patients experienced significant temperature change at all intervals (P < .001), with the greatest loss occurring during the preprocedure interval (between leaving preprocedure unit and anesthesia induction). On adjusted analysis, patients who experienced inadvertent perioperative hypothermia less than 35.5 °C were older (odds ratio, 1.03; 95% CI, 1.01-1.05), had lower body mass index (odds ratio, 0.95; 95% CI, 0.87-0.98), and had increasing operative time (odds ratio, 1.00; 95% CI, 1.00-1.01). Patients who experienced inadvertent perioperative hypothermia had higher risk-adjusted rates of overall morbidity and infectious postoperative complications. CONCLUSIONS The majority of patients undergoing robotic-assisted thoracic surgery lung resections experience some degree of inadvertent perioperative hypothermia and have associated increased rates of 30-day morbidity. Structured and interval-specific interventions should be implemented to decrease rates of inadvertent perioperative hypothermia and subsequent complications.
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Affiliation(s)
- Christina M Stuart
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo.
| | - Adam R Dyas
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo
| | - Michael R Bronsert
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colo
| | - Benjamin A Abrams
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, Colo
| | - Alyson D Kelleher
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo
| | - Kathryn L Colborn
- Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colo
| | - Simran K Randhawa
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo
| | - Elizabeth A David
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo
| | - John D Mitchell
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo
| | - Robert A Meguid
- Department of Surgery, University of Colorado School of Medicine, Aurora, Colo; Surgical Outcomes and Applied Research, University of Colorado School of Medicine, Aurora, Colo; Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colo
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Yang H, Gu S, Fan J, Li W. Factors Influencing the Occurrence of Intraoperative Hypothermia in Patients Undergoing General Anesthesia Intervention: A Study in a Tertiary Care Hospital. Med Sci Monit 2024; 30:e943463. [PMID: 38509664 DOI: 10.12659/msm.943463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Intraoperative and postoperative hypothermia of patients can be caused by the use of anesthetic drugs and the complicated and time-consuming procedures of interventional surgery. This retrospective study included 184 patients to investigate the incidence and factors associated with hypothermia during intraoperative anesthesia in a single center in China between January and October 2023. MATERIAL AND METHODS A convenient sampling method was used to select 184 patients who underwent general anesthesia intervention in a tertiary hospital in Sichuan Province from January to October 2023 as the study population. The independent factors influencing the occurrence of intraoperative hypothermia were analyzed. A survey was conducted to collect 5 demographic factors, 4 preoperative-related factors, and 10 surgically related factors. According to the occurrence of intraoperative hypothermia, the independent influencing factors of unplanned hypothermia during perioperative period were further analyzed. RESULTS Among 184 patients, 64 (34.78%) experienced perioperative unplanned hypothermia, of which 5 (7.81%) cases occurred before the start of surgery, 7 (10.94%) occurred before the start of surgery after anesthesia, and 52 (81.25%) occurred during surgery. Logistic regression analysis showed that body temperature at the beginning of surgery (P<0.001), set operating room temperature (P<0.001), duration of anesthesia (P=0.006), and age (P=0.001) were independent influencing factors for unplanned hypothermia during perioperative period. CONCLUSIONS The incidence of intraoperative hypothermia is high in patients undergoing general anesthesia interventions. Age, duration of anesthesia, set operating room temperature, and body temperature at the beginning of the operation were independent influencing factors for the occurrence of unplanned hypothermia during the perioperative period.
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Affiliation(s)
- Huiqiong Yang
- Interventional Radiology Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Sang Gu
- Interventional Radiology Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Juan Fan
- Interventional Radiology Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
| | - Wei Li
- Interventional Radiology Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China (mainland)
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Carter M, Inge M, Zeineddin S, Linton SC, Pitt JB, Robson P, Abdullah F, Goldstein SD. Measurement and Thermodynamic Modeling of Energy Flux During Intercostal Nerve Cryoablation. J Surg Res 2024; 293:231-238. [PMID: 37797391 DOI: 10.1016/j.jss.2023.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/27/2023] [Accepted: 08/27/2023] [Indexed: 10/07/2023]
Abstract
INTRODUCTION Intercostal nerve cryoablation is an increasingly adopted technique to decrease postoperative pain in patients undergoing surgical correction of pectus excavatum (SCOPE). Concerns regarding cryo-induced systemic hypothermia have been raised in pediatric patients; however, assessment of a cooled cryoprobe on body temperature has not been performed. We aimed to determine the energy flux from a maximally cooled cryoprobe and model the possible effects on a whole-body system. METHODS To directly measure energy flux, a maximally cooled cryoSPHERE probe (AtriCure, Inc, Mason, OH) was isolated in a well-mixed water bath at 37°C. Real-time temperatures were recorded. Three models were created to estimate intraoperative flux. Perioperative temperatures of 50 patients who received cryoablation during SCOPE were compared to 50 patients who did not receive cryoablation. RESULTS Direct calorimetry measured average energy flux of the maximally cooled cryoprobe to be 28 J/s. Thermodynamic modeling demonstrated the following: 1) The highest possible cryoprobe flux is less than estimated basal metabolic rate (BMR) of the average teenager undergoing SCOPE and 2) Flux in a best model of human tissue energy transfer using available literature is far less than the effects of BMR and insensible losses. Clinically, there were no significant differences in the minimum intraoperative, end procedure or first postoperative body temperatures for patients who received cryoablation and those who did not. CONCLUSIONS Cryoprobe flux is significantly fewer joules per second than BMR. Furthermore, in a clinical series there were no empiric differences in body temperature due to cryoablation employment, contradicting concerns regarding hypothermia secondary to cryoablation.
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Affiliation(s)
- Michela Carter
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
| | - Madeline Inge
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Suhail Zeineddin
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Samuel C Linton
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - J Benjamin Pitt
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Philip Robson
- Biomedical Engineering and Imaging Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Fizan Abdullah
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Seth D Goldstein
- Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Zhou YD, Zhang WY, Xie GH, Ye H, Chu LH, Guo YQ, Lou Y, Fang XM. Inadvertent perioperative hypothermia and surgical site infections after liver resection. Hepatobiliary Pancreat Dis Int 2023:S1499-3872(23)00244-8. [PMID: 38185585 DOI: 10.1016/j.hbpd.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/01/2023] [Indexed: 01/09/2024]
Abstract
BACKGROUND In the overall surgical population, inadvertent perioperative hypothermia has been associated with an increased incidence of surgical site infection (SSI). However, recent clinical trials did not validate this notion. This study aimed to investigate the potential correlation between inadvertent perioperative hypothermia and SSIs following liver resection. METHODS This retrospective cohort study included all consecutive patients who underwent liver resection between January 2019 and December 2021 at the First Affiliated Hospital, Zhejiang University School of Medicine. Perioperative temperature managements were implemented for all patients included in the analysis. Estimated propensity score matching (PSM) was performed to reduce the baseline imbalances between the normothermia and hypothermia groups. Before and after PSM, univariate analyses were performed to evaluate the correlation between hypothermia and SSI. Multivariate regression analysis was performed to determine whether hypothermia was an independent risk factor for postoperative transfusion and major complications. Subgroup analyses were performed for diabetes mellitus, age > 65 years, and major liver resection. RESULTS Among 4000 patients, 2206 had hypothermia (55.2%), of which 150 developed SSI (6.8%). PSM yielded 1434 individuals in each group. After PSM, the hypothermia and normothermia groups demonstrated similar incidence rates of SSI (6.3% vs. 7.0%, P = 0.453), postoperative transfusion (13.3% vs. 13.7%, P = 0.743), and major complications (9.0% vs. 10.1%, P = 0.309). Univariate regression analysis revealed no significant effects of hypothermia on the incidence of SSI in the group with the highest hypothermia exposure [odds ratio (OR) = 1.25, 95% confidence interval (CI): 0.84-1.87, P = 0.266], the group with moderate exposure (OR = 1.00, 95% CI: 0.65-1.53, P = 0.999), or the group with the lowest exposure (OR = 1.11, 95% CI: 0.73-1.65, P = 0.628). The subgroup analysis revealed similar results. Regarding liver function, patients in the hypothermia group demonstrated lower γ-glutamyl transpeptidase (37 vs. 43 U/L, P = 0.001) and alkaline phosphatase (69 vs. 72 U/L, P = 0.016). However, patients in the hypothermia group exhibited prolonged activated partial thromboplastin time (29.2 vs. 28.6 s, P < 0.01). CONCLUSIONS In our study of patients undergoing liver resection, we found no significant association between mild perioperative hypothermia and SSI. It might be due to the perioperative temperature managements, especially active warming measures, which limited the impact of perioperative hypothermia on the occurrence of SSI.
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Affiliation(s)
- Yi-De Zhou
- Department of Anesthesiology and Intensive Care Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Wen-Yuan Zhang
- Department of Anesthesiology and Intensive Care Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Guo-Hao Xie
- Department of Anesthesiology and Intensive Care Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Hui Ye
- Department of Anesthesiology and Intensive Care Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Li-Hua Chu
- Department of Anesthesiology and Intensive Care Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Yu-Qian Guo
- Department of Anesthesiology and Intensive Care Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Yi Lou
- Department of Anesthesiology and Intensive Care Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
| | - Xiang-Ming Fang
- Department of Anesthesiology and Intensive Care Medicine, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
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Zhao B, Zhu Z, Qi W, Liu Q, Zhang Q, Jiang L, Wang C, Weng X. Construction and validation of a risk prediction model for intraoperative hypothermia in elderly patients undergoing total hip arthroplasty. Aging Clin Exp Res 2023; 35:2127-2136. [PMID: 37490260 PMCID: PMC10520156 DOI: 10.1007/s40520-023-02500-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 07/07/2023] [Indexed: 07/26/2023]
Abstract
AIMS To construct and validate an intraoperative hypothermia risk prediction model for elderly patients undergoing total hip arthroplasty (THA). METHODS We collected data from 718 patients undergoing THA in a tertiary hospital from January 2021 to December 2022. Of these patients, 512 were assigned to the modeling group from January 2021 to April 2022, and 206 participants were assigned to the validation group from May 2022 to December 2022. A logistic regression analysis was performed to construct the model. The area under the curve (AUC) was used to test the model's predictive ability. RESULTS The incidence rate of intraoperative hypothermia was 51.67%. The risk factors entered into the risk prediction model were age, preoperative hemoglobin level, intraoperative blood loss, postoperative hemoglobin level, and postoperative systolic blood pressure. The model was constructed as follows: logit (P) = - 10.118 + 0.174 × age + 1.366 × 1 (preoperative hemoglobin level) + 0.555 × 1 (postoperative hemoglobin level) + 0.009 × 1 (intraoperative blood loss) + 0.066 × 1 (postoperative systolic blood pressure). Using the Hosmer-Lemeshow test, the P value was 0.676 (AUC, 0.867). The Youden index, sensitivity, and specificity were 0.602, 0.790, and 0.812, respectively. The incidence rates of intraoperative hypothermia in the modeling and validation groups were 53.15% and 48.06%, respectively. The correct practical application rate was 89.81%. This model had good application potential. CONCLUSIONS This risk prediction model has good predictive value and can accurately predict the occurrence of intraoperative hypothermia in patients who undergo THA, which provides reliable guidance for clinical work and has good clinical application value.
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Affiliation(s)
- Bin Zhao
- Department of Anesthesiology and SICU, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Kongjiang Road 1665, Shanghai, 200092, China
| | - Zhe Zhu
- Department of Anesthesiology and SICU, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Kongjiang Road 1665, Shanghai, 200092, China
| | - Wenwen Qi
- Department of Psychogeriatric, School of Medicine, Shanghai Mental Health Center, Shanghai Jiao Tong University, South Wanping Road 600, Shanghai, 200030, China
| | - Qiuli Liu
- Department of Anesthesiology and SICU, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Kongjiang Road 1665, Shanghai, 200092, China
| | - Qi Zhang
- Department of Emergency, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Kongjiang Road 1665, Shanghai, 200092, China
| | - Liping Jiang
- Department of Nursing, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Kongjiang Road 1665, Shanghai, 200092, China.
| | - Chenglong Wang
- Department of Orthopaedic Surgery, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Kongjiang Road 1665, Shanghai, 200092, China.
| | - Xiaojian Weng
- Department of Anesthesiology and SICU, School of Medicine, Xinhua Hospital, Shanghai Jiao Tong University, Kongjiang Road 1665, Shanghai, 200092, China.
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Aljaffary A, AlAnsari F, Alatassi A, AlSuhaibani M, Alomran A. Assessing the Precision of Surgery Duration Estimation: A Retrospective Study. J Multidiscip Healthc 2023; 16:1565-1576. [PMID: 37309537 PMCID: PMC10257906 DOI: 10.2147/jmdh.s403756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/30/2023] [Indexed: 06/14/2023] Open
Abstract
Background and Objectives The operating room (OR) is considered the highest source of cost and earnings. Therefore, measuring OR efficiency, which means how time and resources are allocated precisely for their intended purposes in the operating room is crucial. Both overestimation and underestimation negatively impact OR efficiency Therefore, hospitals defined metrics to Measuring OR Effeciency. Many studies have discussed OR efficiency and how surgery scheduling accuracy plays a vital role in increasing OR efficiency. This study aims to evaluate OR efficiency using surgery duration accuracy. Methods This retrospective, quantitative study was conducted at King Abdulaziz Medical City. We extracted data on 97,397 surgeries from 2017 to 2021 from the OR database. The accuracy of surgery duration was identified by calculating the duration of each surgery in minutes by subtracting the time of leaving the OR from the time of entering the OR. Based on the scheduled duration, the calculated durations were categorized as either underestimation or overestimation. Descriptive and bivariate analyses (Chi-square test) were performed using the Statistical Package for the Social Sciences (SPSS) software. Results Sixty percent out of the 97,397 surgeries performed were overestimated compared to the time scheduled by the surgeons. Patient characteristics, surgical division, and anesthesia type showed statistically significant differences (p <0.05) in their OR estimation. Conclusion Significant proportion of procedures have overestimated. This finding provides insight into the need for improvement. Recommendations It is recommended to enhance the surgical scheduling method using machine learning (ML) models to include patient characteristics, department, anesthesia type, and even the performing surgeon increases the accuracy of duration estimation. Then, evaluate the performance of an ML model in future studies.
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Affiliation(s)
- Afnan Aljaffary
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Fatimah AlAnsari
- Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdulaleem Alatassi
- Preoperative Quality and Patient Safety Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Mohammed AlSuhaibani
- Operating Room Services Department, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Ammar Alomran
- Department of Orthopedic, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Risk factors and prediction model for inadvertent intraoperative hypothermia in patients undergoing robotic surgery: a retrospective analysis. Sci Rep 2023; 13:3687. [PMID: 36878972 PMCID: PMC9988985 DOI: 10.1038/s41598-023-30819-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/02/2023] [Indexed: 03/08/2023] Open
Abstract
This study explored the risk factors and established a prediction model for intraoperative hypothermia (IOH) in patients undergoing robotic surgery. We conducted a retrospective survey of patients undergoing elective robotic surgery at the China-Japan Union Hospital of Jilin University during June 2020-October 2021 using institutional medical records. Intraoperative core temperatures and potential influencing factors were collected, and regression analyses were used to assess the risk factors for IOH and establish a prediction model for the incidence of IOH. Overall, 833 patients who underwent robotic surgery were included in the final analysis; IOH was observed in 344 patients (incidence, 0.41; 95% confidence interval [CI] 0.38-0.45). A higher body mass index (BMI) and baseline core temperature were protective factors for IOH. A final prediction model for IOH was developed based on the determining factors with an area under the receiver operating characteristic curve of 0.85 under fivefold cross validation (95% CI 0.83-0.88). Accordingly, a lower BMI and baseline core temperature, thoracic surgeries, morning surgeries, and surgeries with longer durations were risk factors for IOH during robotic surgeries. Our prediction model has an excellent discrimination ability for predicting IOH in robotic surgeries.
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The effects of prolonged intraoperative hypothermia on patient outcomes in immediate implant-based breast reconstruction. J Plast Reconstr Aesthet Surg 2023; 77:1-7. [PMID: 36543055 DOI: 10.1016/j.bjps.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 09/01/2022] [Accepted: 11/15/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND The importance of thermoregulation in surgical procedures has become a recent focus for anesthesiologists and surgeons to improve patient outcomes. In breast surgery, maintenance of normothermia has been shown to reduce surgical-site infections. However, there is a paucity of information evaluating the relationship between intraoperative core body temperatures and reconstructive surgical outcomes. METHODS A retrospective review of patients who underwent immediate breast reconstruction following mastectomy from 2015 to 2020 was performed. Patients were classified into a majority normothermic (NT) group if patients spent greater than half of the operative time ≥36 °C or a majority hypothermic (HT) group if patients spent greater than or equal to half of the operative time <36 °C. Patient demographics, comorbidities, surgical techniques, and postoperative complications were recorded. Complications were classified according to the Clavien-Dindo Classification. Univariate and multivariate statistics were used to assess significant relationships. RESULTS A total of 329 patients met inclusion criteria, of which 174 were in the NT group and 155 were in the HT group, yielding 302 and 264 total breasts, respectively. There was no significant difference in rates of infection (p = 1.0), seroma (p = 0.27), hematoma (p = 0.61), or wound dehiscence (p = 1.0). However, patients in the HT group had significantly more overall ischemic complications (p = 0.009) and, specifically, grade IIIb ischemic complications (p = 0.04). After controlling for tobacco use, body mass index, mastectomy pattern, radiation, operating surgeon, and mastectomy weight, multivariate analysis showed increased ischemic complications in the HT group (p = 0.04). CONCLUSION Prolonged intraoperative hypothermia can increase the risk for the development of ischemic wounds such as tissue necrosis or eschar formation that require operative intervention. This presents reconstructive complications that increase both patient and health system burdens that could be addressed through the maintenance of normothermia. Further studies using real-time flap temperature would provide more accurate insight into the relationship between temperature and implant-based breast reconstruction.
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Yan Y, Geng J, Cui X, Lei G, Wu L, Wang G. Thoracic Paravertebral Block Decreased Body Temperature in Thoracoscopic Lobectomy Patients: A Randomized Controlled Trial. Ther Clin Risk Manag 2023; 19:67-76. [PMID: 36713292 PMCID: PMC9880011 DOI: 10.2147/tcrm.s392961] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/12/2023] [Indexed: 01/21/2023] Open
Abstract
Purpose Thoracic paravertebral block (TPVB) may be highly beneficial for thoracoscopic lobectomy patients, but it may increase the risk of hypothermia. Apart from its anesthetic-reducing effects, this randomized controlled trial aimed to investigate the hypothermic effect of TPVB, and thus optimize its clinical use. Patients and methods Adult patients were randomly allocated to two groups: TPVB + general anesthesia (GA) group or GA group. In the TPVB+GA group, the block was performed after GA induction by an experienced but unrelated anesthesiologist. Both the lower esophageal and axillary temperature were recorded at the beginning of surgery (T0) and every 15 min thereafter (T1-T8), and the end of surgery (Tp). The primary outcome was the lower esophageal temperature at Tp. The secondary outcomes included lower esophageal temperature from T0-T8 and axillary temperature from T0-Tp. The total propofol, analgesics, and norepinephrine consumption and the incidence of adverse events were also recorded. Results Forty-eight patients were randomly allocated to the TPVB+GA (n=24) and GA (n=24) groups. The core temperature at the end of the surgery was lower in the TPVB+GA group than the GA group (35.90±0.30°C vs 36.35±0.33°C, P<0.001), with a significant difference from 45 min after the surgery began until the end of the surgery (P<0.05). In contrast, the peripheral temperature showed a significant difference at 60 min after the surgery began till the end (P<0.05). TPVB+GA exhibited excellent analgesic and sedative-sparing effects compared to GA alone (P<0.001), though it increased norepinephrine consumption due to hypotension (P<0.001). Conclusion Although thorough warming strategies were used, TPVB combined with GA remarkably reduced the body temperature, which is an easily neglected side effect. Further studies on the most effective precautions are needed to optimize the clinical use of TPVB.
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Affiliation(s)
- Yanhong Yan
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Jiao Geng
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Xu Cui
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Guiyu Lei
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Lili Wu
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China
| | - Guyan Wang
- Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, Beijing, People’s Republic of China,Correspondence: Guyan Wang, Department of Anesthesiology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaomingxiang, Beijing, 100730, People’s Republic of China, Tel +86-13910985139, Fax +86-10-58268017, Email
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An Overview of the Implications for Perianesthesia Nurses in terms of Intraoperative Changes in Temperature and Factors Associated with Unintentional Postoperative Hypothermia. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:6955870. [PMID: 35444780 PMCID: PMC9015883 DOI: 10.1155/2022/6955870] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022]
Abstract
Patients undergo surgery and anaesthesia on a daily basis across the United States and throughout the world. A major source of worry for these patients continues to be inadvertent hypothermia, once core temperature <36°C (96.8°F). Despite well-documented adverse physiological consequences, anaesthesia nurses continue to have a difficult task in keeping patient warmth pre-/peri-/post-surgical procedure. Thermostasis within postoperative patient necessitates the collaboration of many individuals. In order to provide safe and high-quality treatment, it is essential to use the most up-to-date data to guide therapeutic procedures targeted at achieving balance body temperature in surgical patients. Providing a review of the physiology of perioperative temperature variations and the comorbidities linked with accidental intraoperative hypothermia, this article will also provide preventive and treatment methods.
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Pu J, Zhao WJ, Xie XF, Huang HP. A Systematic Review and Meta-Analysis of Risk Factors for Unplanned Intraoperative Hypothermia Among Adult Surgical Patients. J Perianesth Nurs 2022; 37:333-338. [DOI: 10.1016/j.jopan.2021.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/04/2021] [Accepted: 08/28/2021] [Indexed: 11/28/2022]
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Varner KL, Hines CB. Reducing Hypothermia After Cardiac Ablation Using the ASPAN Normothermia Guidelines. J Perianesth Nurs 2022; 37:162-166. [DOI: 10.1016/j.jopan.2021.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/16/2021] [Accepted: 03/28/2021] [Indexed: 10/19/2022]
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Cho SA, Lee SJ, Yoon S, Sung TY. Risk Factors for Postoperative Hypothermia in Patients Undergoing Robot-Assisted Gynecological Surgery: A Retrospective Cohort Study. Int J Med Sci 2022; 19:1147-1154. [PMID: 35919810 PMCID: PMC9339412 DOI: 10.7150/ijms.73225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/15/2022] [Indexed: 11/05/2022] Open
Abstract
Since postoperative hypothermia increases the morbidity and mortality rates of surgery, identifying its risk factors is an important part of perioperative management. Considering the increasing demand for robot-assisted surgery and other characteristics of conventional laparoscopic surgery, identifying the risk factors for hypothermia in robot-assisted surgery is necessary. However, this has not yet been clearly established. This study aimed to identify the risk factors and incidence rate of postoperative hypothermia in patients undergoing robot-assisted gynecological surgery. In total, 516 patients aged ≥ 19 years undergoing robot-assisted gynecological surgery at a single university hospital between January 2018 and November 2020 were retrospectively analyzed. Postoperative hypothermia was defined as 36.0°C or lower body temperature at the end of the surgery, and multivariate logistic regression analysis was performed to identify the risk factors for postoperative hypothermia. Among the 516 patients, the incidence rate of postoperative hypothermia was 28.1% in 145 patients. The independent risk factors for postoperative hypothermia included body mass index ≤ 22.9 kg/m2, baseline heart rate ≤ 73 rate/min, baseline body temperature ≤ 36.8°C, use of intraoperative nicardipine, and amount of administered intravenous fluid larger than 800 mL. Therefore, to prevent hypothermia in patients undergoing robot-assisted gynecological surgery, these risk factors must be considered.
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Affiliation(s)
- Sung-Ae Cho
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon, Korea
| | - Seok-Jin Lee
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon, Korea
| | - Sieun Yoon
- Department of Anaesthesiology and Pain medicine, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Tae-Yun Sung
- Department of Anaesthesiology and Pain Medicine, Konyang University Hospital, Myunggok Medical Research Center, Konyang University College of Medicine, Daejeon, Korea
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Yan L, Yao L, Zhao Q, Xiao M, Li Y, Min S. Risk Prediction Models for Inadvertent Intraoperative Hypothermia: A Systematic Review. J Perianesth Nurs 2021; 36:724-729. [PMID: 34663532 DOI: 10.1016/j.jopan.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/27/2021] [Accepted: 02/27/2021] [Indexed: 10/20/2022]
Abstract
PURPOSES Inadvertent intraoperative hypothermia (core temperature <36°C) is a common surgical complication with several adverse events. Hypothermia prediction models can be a tool for providing the healthcare staff with information on the risk of inadvertent hypothermia. Our systematic review aimed to identify, demonstrate, and evaluate the available intraoperative hypothermia risk prediction models in surgical populations. DESIGN This study is a systematic review of literature. METHODS We systematically searched multiple databases (Ovid MEDLINE, Web of Science, Embase, and Cochrane Center Register of Controlled Trials). Two reviewers independently examined abstracts and the full text for eligibility. Data collection was guided by the CHecklist for critical Appraisal and data extraction for systematic Reviews of prediction Modelling Studies (CHARMS checklist), and methodological quality and applicability were assessed by the Prediction model Risk Of Bias ASsessment Tool (PROBAST). FINDINGS A total of 3,672 references were screened, of which eight articles were included in this study. All the models had a high risk of bias since most of them lacked model validation. Also, they failed to report the model performance and final model presentations, which restricted their clinical application. CONCLUSIONS The researchers should present models in a more standard way and improve the existing models to increase their predictive values for clinical application.
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Affiliation(s)
- Lupei Yan
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lili Yao
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qinghua Zhao
- Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Mingzhao Xiao
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yuerong Li
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Su Min
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Chen HY, Su LJ, Wu HZ, Zou H, Yang R, Zhu YX. Risk factors for inadvertent intraoperative hypothermia in patients undergoing laparoscopic surgery: A prospective cohort study. PLoS One 2021; 16:e0257816. [PMID: 34555101 PMCID: PMC8460038 DOI: 10.1371/journal.pone.0257816] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/11/2021] [Indexed: 12/02/2022] Open
Abstract
Background Inadvertent intraoperative hypothermia is frequent during open surgeries; however, few studies on hypothermia during laparoscopic abdominal surgery have been reported. We aimed to investigate the incidence and risk factors for hypothermia in patients undergoing laparoscopic abdominal surgery. Methods This single-center prospective cohort observational study involved patients undergoing laparoscopic surgery between October 2018 and June 2019. Data on core body temperature and potential variables were collected. A multivariate logistic regression analysis was performed to identify the risk factors associated with hypothermia. A Cox regression analysis was used to verify the sensitivity of the results. Results In total, 690 patients were included in the analysis, of whom 200 (29.0%, 95% CI: 26%−32%) had a core temperature < 36°C. The core temperature decreased over time, and the incident hypothermia increased gradually. In the multivariate logistic regression analysis, age (OR = 1.017, 95% CI: 1.000–1.034, P = 0.050), BMI (OR = 0.938, 95% CI: 0.880–1.000; P = 0.049), baseline body temperature (OR = 0.025, 95% CI: 0.010–0.060; P < 0.001), volume of irrigation fluids (OR = 1.001, 95% CI: 1.000–1.001, P = 0.001), volume of urine (OR = 1.001, 95% CI: 1.000–1.003, P = 0.070), and duration of surgery (OR = 1.010, 95% CI: 1.006–1.015, P < 0.001) were significantly associated with hypothermia. In the Cox analysis, variables in the final model were age, BMI, baseline body temperature, volume of irrigation fluids, blood loss, and duration of surgery. Conclusions Inadvertent intraoperative hypothermia is evident in patients undergoing laparoscopic surgeries. Age, BMI, baseline body temperature, volume of irrigation fluids, and duration of surgery are significantly associated with intraoperative hypothermia.
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Affiliation(s)
- Huai-Ying Chen
- Department of Nursing, Ningde Municipal Hospital of Ningde Normal University, Ningde, China
- * E-mail:
| | - Li-Jing Su
- Department of Nursing, Ningde Municipal Hospital of Ningde Normal University, Ningde, China
- The School of Nursing, Fujian Medical University, Fuzhou, China
| | - Hang-Zhou Wu
- Department of Medical Insurance, Fujian Medical University Union Hospital, Fuzhou, China
| | - Hong Zou
- Department of Clinical Laboratory, Fujian Medical University Union Hospital, Fuzhou, China
| | - Rong Yang
- Department of Medical Record Management, Fujian Medical University Union Hospital, Fuzhou, China
| | - Yi-Xia Zhu
- Department of Anesthesiology, Ningde Municipal Hospital of Ningde Normal University, Ningde, China
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Ukrani RD, Arif A, Sadruddin A, Hasan O, Noordin S. Intraoperative hypothermia in patients undergoing Total knee arthroplasty: a cross-sectional study from a developing country. BMC Musculoskelet Disord 2021; 22:504. [PMID: 34059046 PMCID: PMC8168312 DOI: 10.1186/s12891-021-04390-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 05/19/2021] [Indexed: 12/02/2022] Open
Abstract
Background Intraoperative hypothermia is associated with various risk factors, morbidity, and mortality in patients undergoing total knee arthroplasty (TKA), increasing the emotional and financial burden on patients. This study aimed to identify risk factors of intraoperative hypothermia in patients undergoing TKA. Materials and methods All adult patients (⩾18 years) who underwent TKA from January 2016 to December 2017 at a tertiary-care hospital in Pakistan were included in this retrospective, cross-sectional study. Temperature < 36 °C was defined as hypothermia. Results The study included 286 patients (77.6% female) with a mean age of 61.4 ± 10.4 years. The overall proportion of intraoperative hypothermia was 26.6%. Of the total patients, 66.1% underwent bilateral TKA whereas 33.9% underwent unilateral TKA. 73.8% of the patients were ASA Level 2. Only 13.3% of patients had postoperative hypothermia. Conclusion Intraoperative hypothermia was significantly associated with age, bilateral procedure, ASA level and postoperative hypothermia in patients undergoing TKA. The surgeon and the operative team should be aware of the risk factors and the adverse outcomes associated with intraoperative hypothermia, especially in resource constrained settings to plan preventive strategies. Trial registration This study was retrospectively registered on ClinicalTrials.gov on 3rd October 2020. The registration ID is NCT04575246.
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Affiliation(s)
| | - Aiman Arif
- Medical College, Aga Khan University Hospital, Karachi, 74800, Pakistan.
| | - Anum Sadruddin
- Department of Orthopaedic Surgery, Aga Khan University Hospital, Karachi, 74800, Pakistan
| | - Obada Hasan
- Department of Orthopaedic Surgery, Aga Khan University Hospital, Karachi, 74800, Pakistan
| | - Shahryar Noordin
- Department of Orthopaedic Surgery, Aga Khan University Hospital, Karachi, 74800, Pakistan
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Yoo JH, Ok SY, Kim SH, Chung JW, Park SY, Kim MG, Cho HB, Song SH, Choi YJ, Kim HJ, Oh HC. Comparison of upper and lower body forced air blanket to prevent perioperative hypothermia in patients who underwent spinal surgery in prone position: A randomized controlled trial. Korean J Anesthesiol 2021; 75:37-46. [PMID: 33984220 PMCID: PMC8831429 DOI: 10.4097/kja.21087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background We compared upper- and lower-body forced-air blankets in terms of their ability to prevent perioperative hypothermia, defined as a reduction in body temperature to < 36.0°C, during the perioperative period in patients undergoing spine surgery in the prone position. Methods In total, 120 patients scheduled for elective spine surgery under general anesthesia were divided into an upper-warming group (n = 60) and a lower-warming group (n = 60). After inducing anesthesia and preparing the patient for surgery, including prone positioning, the upper and lower bodies of the patients in the upper- and lower-warming groups, respectively, were warmed using a forced-air warmer with specified upper and lower blankets. Body temperature was measured using a tympanic membrane thermometer during the pre- and post-operative periods and using a nasopharyngeal temperature probe during the intraoperative period. Patients were evaluated in terms of shivering, thermal comfort, and satisfaction in the post-anesthesia care unit (PACU). Results The incidence of intraoperative and postoperative hypothermia was lower in the upper-warming group than in the lower-warming group ([55.2% vs. 75.9%, P = 0.019] and [21.4% vs. 49.1%, P = 0.002]). Perioperative body temperature was higher in the upper-warming group (P < 0.001). However, intraoperative blood loss, postoperative thermal comfort scale and shivering scores, patient satisfaction, and PACU duration were similar in the two groups. Conclusions The upper-body blanket was more effective than the lower-body blanket for preventing perioperative hypothermia in patients who underwent spine surgery in the prone position.
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Affiliation(s)
- Jae Hwa Yoo
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Republic of Korea
| | - Si Young Ok
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Republic of Korea
| | - Sang Ho Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Republic of Korea
| | - Ji Won Chung
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Republic of Korea
| | - Sun Young Park
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Republic of Korea
| | - Mun Gyu Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Republic of Korea
| | - Ho Bum Cho
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Republic of Korea
| | - Sang Hoon Song
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Republic of Korea
| | - Yun Jeong Choi
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Republic of Korea
| | - Hyun Ju Kim
- Department of Anesthesiology and Pain Medicine, Soonchunhyang University Hospital Seoul, Republic of Korea
| | - Hong Chul Oh
- Department of Thoracic and Cardiovascular surgery, Soonchunhyang University Hospital Seoul, Republic of Korea
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Correlation between the Perfusion Index and Intraoperative Hypothermia: A Prospective Observational Pilot Study. ACTA ACUST UNITED AC 2021; 57:medicina57040364. [PMID: 33917932 PMCID: PMC8068332 DOI: 10.3390/medicina57040364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/03/2021] [Accepted: 04/07/2021] [Indexed: 12/23/2022]
Abstract
Background and Objectives: We examined the association between the baseline perfusion index (PI) and changes in intraoperative body temperature during general anesthesia. The PI reflects the peripheral perfusion state. The PI may be associated with changes in body temperature during general anesthesia because the degree of redistribution of body heat from the central to the peripheral compartment varies depending on the peripheral perfusion state. Materials and Methods: Thirty-eight patients who underwent brain surgery were enrolled in this study. The baseline PI and body temperature of the patients were measured on entering the operating room. Body temperature was recorded every 15 min after induction of anesthesia using an esophageal temperature probe. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for intraoperative hypothermia. Results: Eighteen patients (47 %) developed hypothermia intraoperatively. The baseline PI was significantly lower among patients in the hypothermia group (1.8 ± 0.7) than among those in the normothermia group (3.0 ± 1.2) (P < 0.001). The baseline PI and body temperature were independently associated with intraoperative hypothermia (PI: odds ratio [OR], 0.270; 95% confidence interval [CI], 0.105-0.697; P = 0.007, baseline body temperature: OR, 0.061; 95% CI, 0.005-0.743; P = 0.028). Conclusions: This study showed that low baseline PI was the factor most related to the development of intraoperative hypothermia. Future studies should consider the PI as a predictor of intraoperative hypothermia.
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Li C, Zhao B, Li L, Na G, Lin C. Analysis of the Risk Factors for the Onset of Postoperative Hypothermia in the Postanesthesia Care Unit. J Perianesth Nurs 2021; 36:238-242. [PMID: 33583724 DOI: 10.1016/j.jopan.2020.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/24/2020] [Accepted: 09/07/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE Recent studies on hypothermia typically focused on a single anesthesia method or a particular surgical procedure. Although there are multiple risk factors leading to hypothermia, such as the use of cold solutions or nonhumidified and nonheated anesthetic gases, few studies have reported the incidence of postoperative hypothermia among patients in the postanesthesia care unit (PACU). DESIGN This is a retrospective analysis of patients who underwent surgery and were admitted to the PACU immediately after surgery at the Fourth Affiliated Hospital, College of Medicine, Zhejiang University, from September 2018 to March 2019. METHODS Patient data were collected and analyzed in two groups to understand the factors affecting the occurrence of hypothermia. Hypothermia was defined as a core temperature of less than 36°C. On the basis of body temperature, patients in the PACU were divided into hypothermic and nonhypothermic groups. Factors influencing hypothermia were studied by the univariate method, followed by logistic regression analysis to identify the risk factors for hypothermia onset. FINDINGS Of a total of 1,788 patients were enrolled in the study, 113 (6.32%) exhibited hypothermia (<36°C) in the PACU. The hypothermic and nonhypothermic groups displayed significant differences (P < .05) in the anesthesia method used as well as the American Society of Anesthesiologists physical classification status. The body temperature at the time the patients were admitted to the operating room influenced the occurrence of postoperative hypothermia (P < .01). These parameters were recognized as independent risk factors for postoperative hypothermia in the PACU. CONCLUSIONS Significant risk factors for the onset of hypothermia were general anesthesia and higher American Society of Anesthesiologists grade. However, epidural anesthesia was found to have a protective effect.
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Affiliation(s)
- Caixia Li
- Department of Anesthesiology, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, P.R. China; Department of Anesthesiology, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu, P.R. China
| | - Bing Zhao
- Department of Anesthesiology, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, P.R. China
| | - Leilei Li
- Department of Anesthesiology, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu, P.R. China
| | - Guiya Na
- Department of Anesthesiology, School of Medicine, The Fourth Affiliated Hospital, Zhejiang University, Yiwu, P.R. China
| | - Caizhao Lin
- Department of Colorectal Surgery, School of Medicine, The First Affiliated Hospital, Zhejiang University, Hangzhou, P.R. China.
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22
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Xiao Y, Zhang R, Lv N, Hou C, Ren C, Xu H. Effects of a preoperative forced-air warming system for patients undergoing video-assisted thoracic surgery: A randomized controlled trial. Medicine (Baltimore) 2020; 99:e23424. [PMID: 33235123 PMCID: PMC7710179 DOI: 10.1097/md.0000000000023424] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The incidence of intraoperative hypothermia is still high despite the proposal of different preventive measures during thoracoscopic surgery. This randomized control study evaluated the effects of 30-minute prewarming combined with a forced-air warming system during surgery to prevent intraoperative hypothermia in patients undergoing video-assisted thoracic surgery under general anesthesia combined with erector spinae nerve block. METHODS Ninety-eight patients were randomly and equally allocated to prewarming or warming groups (n = 49 each). The primary outcome was the incidence of intraoperative hypothermia. Secondary outcomes were core temperature, irrigation and infused fluid, estimated blood loss, urine output, type of surgery, intraoperative anesthetic dosage, hemodynamics, recovery time, the incidence of postoperative shivering, thermal comfort, postoperative sufentanil consumption and pain intensity, patient satisfaction, and adverse events. RESULTS The incidence of intraoperative hypothermia was significantly lower in the prewarming group than the warming group (12.24% vs 32.65%, P = .015). Core temperature showed the highest decrease 30 minutes after surgery start in both groups; however, the rate was lower in the prewarming than in the warming group (0.31 ± 0.04°C vs 0.42 ± 0.06°C, P < .05). Compared with the warming group, higher core temperatures were recorded for patients in the prewarming group from T1 to T6 (P < .05). Significantly fewer patients with mild hypothermia were in the prewarming group (5 vs 13, P = .037) and recovery time was significantly reduced in the prewarming group (P < .05). Although the incidence of postoperative shivering was lower in the prewarming group, it was not statistically significant (6.12% vs 18.37%, P = .064). Likewise, the shivering severity was similar for both groups. Thermal comfort was significantly increased in the prewarming group, although patient satisfaction was comparable between the 2 groups (P > .05). No adverse events occurred associated with the forced-air warming system. Both groups shared similar baseline demographics, type of surgery, total irrigation fluid, total infused fluid, estimated blood loss, urine output, intraoperative anesthetic dosage, hemodynamics, duration of anesthesia and operation time, postoperative sufentanil consumption, and pain intensity. CONCLUSION In patients undergoing video-assisted thoracic surgery, prewarming for 30 minutes before the induction of anesthesia combined with a forced-air warming system may improve perioperative core temperature and the thermal comfort, although the incidence of postoperative shivering and severity did not improve.
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Affiliation(s)
| | | | - Na Lv
- Department of Operation Room
| | | | - Chunguang Ren
- Department of Anaesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Huiying Xu
- Department of Anaesthesiology, Liaocheng People's Hospital, Liaocheng, Shandong, China
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