Abstract
BackgroundInadvertent perioperative hypothermia (IPH) leads to surgical complications and increases length of stay. IPH rates are high with the current standard of care, forced air warming (FAW). Our hypothesis is that a prototype thermal compression device that heats the popliteal fossa and soles of the feet, with lower leg compression, increases perioperative temperatures and reduces IPH compared to the current standard of care.MethodsThirty six female breast surgery patients, at a tertiary academic hospital, were randomized to the device or intraoperative FAW (stage I) with a further 18 patients randomized to the device with a single heating area only (stage II, popliteal fossa or sole of the feet). Stage I: 37 patients recruited (final 36). Stage II: 18 patients recruited (final 18). Inclusion criteria: general anesthesia with esophageal monitoring for over 30 min, legs available and able to fit the device and no contraindications to leg heating or compression. The intervention was: Stage I: Investigational prototype thermal compression device (full device group) or intraoperative FAW. Stage II: Device with only a single heating location. Primary outcomes were perioperative temperatures and incidence of IPH. Secondary outcomes were local skin temperature, general and thermal comfort scores and presence of perioperative complications, including blood loss.ResultsMean temperatures in the full device group were significantly higher than the FAW group in the pre-operative (36.7 vs 36.4 °C, p < 0.001), early intraoperative (36.3 vs 35.9 °C, p < 0.001), intraoperative (36.6 vs 36.2 °C, p < 0.001) and postoperative periods (36.8 vs 36.5 °C, p < 0.001). The incidence of IPH in the device group was also significantly lower (16.7% vs 72.0%, p = 0.001). Thermal comfort scores were significantly higher in the full device group and hypothermia associated wound complications were higher in the FAW group.ConclusionsThe thermal compression device is feasible and has efficacy over the FAW. Further studies are recommended to investigate clinically significant outcomes.Trial registrationclinicaltrials.gov (NCT02155400)
Highlights
Inadvertent perioperative hypothermia (IPH) leads to surgical complications and increases length of stay
IPH is associated with cardiac morbidity, wound infection, intraoperative blood loss and increased post-operative care unit (PACU) and hospital length of stay [1, 5, 6]
There was no difference in age, Body Mass Index (BMI), operating time, American Society for Anesthesiology (ASA) grade, between full device and forced air warming (FAW) groups
Summary
Inadvertent perioperative hypothermia (IPH) leads to surgical complications and increases length of stay. IPH rates are high with the current standard of care, forced air warming (FAW). IPH is associated with cardiac morbidity, wound infection, intraoperative blood loss and increased post-operative care unit (PACU) and hospital length of stay [1, 5, 6]. The standard of care for preventing IPH is intraoperative forced air warming (FAW). There have been efforts to implement preoperative FAW with limited success [7, 11,12,13,14,15,16,17,18,19] They are cumbersome, not transported with the patient and can and unknowingly be disconnected during transit to the operating room [7, 20,21,22]
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