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Study cites risk factors for intraoperative hypothermia in TJA
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Female patients and patients who had general anesthesia during total joint arthroplasty had a significant risk for intraoperative hypothermia, according to results.
Using statistical analysis, researchers evaluated the rate of intraoperative hypothermia and the effect of the condition on the complications and outcomes of 2,397 patients who underwent total knee arthroplasty (TKA) or total hip arthroplasty (THA). Researchers recorded patient demographic data, surgery-specific data, postoperative complications, length of hospital stay and 30-day readmission. Hypothermia was defined as a mean intraoperative temperature of less than 36° C, according to researchers.
Results showed an overall incidence of intraoperative hypothermia of 37%, with a higher incidence found among patients undergoing THA, especially women. Researchers noted a significant association between general anesthesia and hypothermia in all cohort analyses. Researchers found an association between increased estimated blood loss and hypothermia. However, according to results, hypothermia did not correlate with an increased risk for transfusion. According to results of a multivariate logistic regression analysis, active re-warmer use correlated with hypothermia in arthroplasty and THA cohorts. Odds of hypothermia also increased with longer OR time, researchers noted. – by Casey Tingle
Disclosures: Frisch reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Douglas A. Dennis, MD
Perioperative hypothermia has been associated with various adverse events, including increased blood loss, higher transfusion rates, impaired wound healing, and an increased risk of surgical site infection and cardiovascular complications. Most analyses have not directly focused on total joint arthroplasty. The current report evaluated the incidence of hypothermia in a cohort of 2,397 patients undergoing either total hip arthroplasty (THA) or total knee arthroplasty (TKA). The authors also attempted to determine factors associated with the development of hypothermia and whether this finding was associated with an increased risk of perioperative complications.
The incidence of hypothermia was 37%, 43.9% and 32.6% for the entire arthroplasty cohort, THA and TKA subjects, respectively. Hypothermia was associated with use of general anesthesia, THA, female gender, longer procedure times and higher magnitudes of blood loss. It was not associated with postoperative complications, length of stay or hospital readmission.
The strengths of this analysis are its focus on a large cohort of subjects requiring hip or knee arthroplasty. It emphasizes the importance of the risk factors and the need for monitoring and hopefully preventing hypothermia. Limitations, all recognized by the authors, include failure to monitor operating room temperature and the method of intraoperative measurement of body temperature was not standardized. Measurement of intraoperative core body temperature through use of urinary catheter, esophageal or endotracheal probes would have enhanced the validity of their findings.
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