Intraoperative Hypothermia in Total Hip and Knee Arthroplasty

Abstract

Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are common and successful orthopedic procedures, and as their frequency continues to increase substantially, the focus on limiting perioperative complications heightens. Intraoperative normothermia is recommended to minimize additional complications, but limited evidence exists regarding the effect of hypothermia on orthopedic patients. The purpose of this retrospective study was to determine the incidence of perioperative hypothermia in the setting of TKA and THA, and to evaluate its impact on complications and outcomes. The clinical records of 2580 consecutive patients who underwent TKA or THA at a single institution between January 1, 2011, and December 31, 2013 were reviewed. After excluding patients with complex or revision procedures, a total of 2397 patients comprised the study population. Patient demographic data, surgery-specific data, postoperative complications, length of hospital stay, and 30-day readmission were recorded. Patients with a mean intraoperative temperature less than 36°C were identified as hypothermic. Statistical analysis evaluated associations with hypothermia and the effect on complications and outcomes. The incidence of mean intraoperative hypothermia was 37%, 43.9%, and 32.6% for arthroplasty, THA, and TKA, respectively. General anesthesia was significantly associated with hypothermia (P<.001). Women and THA patients were at higher risk for hypothermia. In the arthroplasty and THA cohorts, longer operating room time and re-warmer use were associated with hypothermia (P=.010). Overall, hypothermia was associated with increased estimated blood loss, but no increase in associated transfusion was demonstrated (P=.006). Hypothermia was not associated with postoperative complications. [Orthopedics. 2017; 40(1):56-63.].

Inadvertent Perioperative Hypothermia Risks and Postoperative Complications: A Retrospective Study

“…Perioperative hypothermia commonly is defined as a body temperature less than or equal to 36.0° C (≤96.8° F) during the perioperative continuum of care . Multiple studies describe negative outcomes associated with inadvertent hypothermia, including surgical site infection, coagulation dysfunction, increased intraoperative blood loss, sepsis, and mortality . Although the seriousness of postoperative complications varies, one research group found that mortality increased fourfold in patients who had experienced perioperative hypothermia .…”

“…The higher incidence of perioperative hypothermia may be related to decreased thermoregulation in older adults . Some studies have shown a significantly higher incidence of perioperative hypothermia in female patients; others show a higher incidence in male patients …”

“…A greater incidence of perioperative hypothermia is associated with open and laparoscopic abdominal procedures, , total knee arthroplasties, and total hip arthroplasties , …”

“…Many patients experience hypothermia during their surgical procedures. Perioperative hypothermia has been documented in patients during various procedures (eg, total hip arthroplasty, colorectal surgeries) with incidence rates ranging from 17.0% to 88.6% depending on the type of surgery …”

Fast Track Surgery Program in Knee Replacement

“…However, some studies showed the contrary result. Even though hypothermia increases the amount of estimated blood loss, it did not increase transfusion rate, postoperative complications, length of hospital stay or the rate of 30-day readmission [34]. In general, it is still recommended that patients' core temperature should be constantly monitored throughout the operation to maintain normothermia status.…”