Utility of Perioperative Warming for the Prevention of Surgical Site Infection and Patient Rehabilitative Complications: A Systematic Review

Abstract

Overview: Surgical site infection (SSI) is a leading cause of postoperative complication, rehospitalisation, and patient mortality after invasive clinical interventions. Surgical risks compounded by SSI introduce greater medical, economic, and quality-of-life challenges for both patients and providers alike, and to better inform clinical practice, empirical evaluation of modern surgical warming techniques is relevant. This systematic review and meta-analysis qualitatively examined the efficacy of both active and passive perioperative warming interventions upon SSI presentation versus standardised (i.e., non-warming) care. Methods: This review analysed available literature on active and passive warming application across general anaesthesia procedures, containing longitudinal data on patient outcomes and SSI. The primary outcome studied was occurrence of post-surgical SSI; secondary outcomes included rehabilitative length of stay, attributable SSI-related mortality, and incidence of re-admittance. Results: Meta-analysis demonstrated a significantly reduced risk ratio for SSI in patients receiving any surgical warming intervention (odds ratio: 0.36; 95% confidence interval: 0.18–0.87; p<0.01) compared to individuals treated under standard care conditions, with limited further data supporting improved active warming effect in contrast with passive implementation. Secondary postoperative outcomes, including length of rehabilitative stay or wound healing score (ASEPSIS), correspondingly demonstrated greater outcomes for surgical patients receiving perioperative warming. Introduction of warming interventions consistently correlated with reduced patient-reported pain experiences (p<0.05) and downstream care expenditures (p<0.01). Conclusion: The present review identified evidence supporting a statistically significant correlation between both active and passive perioperative warming interventions to SSI prevention. These findings strongly support the recommendation of standardised perioperative warming implementation with continued investigation of relative efficacy contrasting active and passive methodologies, and across more diverse and substantial patient population sizes.