Avoiding Unintentional Hypothermia During Prosthetic Joint Replacement Surgery

Abstract

Fig 1. Efficacy of Solution C for disinfection of hospital equipment. Background/Objectives: Hypothermia during the intraoperative period is associated with an increased risk of developing a surgical site infection. Despite using both a forced warm air jacket preoperatively and blanket during surgery, 36% of prosthetic joint replacement patients did not achieve normothermia during the intraoperative period. Due to the surgeon's concern that the forced air motorwould increase room contaminants, the forced air blanket was not turned on until the patient's skin preparation and draping was accomplished, often leading to unintentional hypothermia. Beginning in September 2011, an underbody disposable waterbased warming pad was added to the operating room (OR) table to be used in conjunction with the forced air modalities. Objectives: The objective of this study was to determine if using an underbody warming device, in addition to the forced warm air modalities would increase the proportion of patients achieving and maintaining normothermia during surgery. Methods: From May to September 2010, the baseline period, intraoperative temperatures were obtained from anesthesia records of 50 patients who underwent joint replacement surgery. The underbody disposable water-based warming pad was implemented for joint replacement surgeries in September 2011. From September 2011 to January 2012, the post intervention period, anesthesia records of 56 patients were reviewed to determine the first and last intraoperative temperatures, as well as the highest and lowest temperature. Temperatures were taken using either a bladder probe or an esophageal probe. Results: During the baseline period 13/50 (26%) of patients were normothermic the entire time they were in the OR, as compared to 29/56 (52%) of patients during the post intervention period (p1⁄40.0067). Thirty-six percent (18/50) of the patients were hypothermic for the duration of the surgical procedure during the baseline period, while there were only 12% (7/56) in the post intervention period (p1⁄40.0044). When comparing the last temperature taken in the operating room; 25/50 (50%) of the patients were normothermic in the baseline period, but 46/56 (82%) were normothermic in the post intervention period (p1⁄40.0004). Conclusions: Conclusions: Using the underbody disposable water based warming pad together with preoperative and intraoperative forced warm air warming modalities increased and maintained patients' body temperature throughout the intraoperative period. These results have supported continued utilization of the underbody warming pad. The adoption of this new warming system contributes to collaborative efforts to reduce postoperative infections in prosthetic joint replacement patients.