R. A. Sorber2, T. C. Crawford2, E. Haut2,3, C. L. Wolfgang2,4, C. Atallah2 2The Johns Hopkins University School Of Medicine,Department Of Surgery,Baltimore, MD, USA 3The Johns Hopkins University School Of Medicine,Johns Hopkins Surgery Center For Outcomes Research (JSCOR),Baltimore, MD, USA 4The Johns Hopkins University School Of Medicine,Divison Of Hepatobiliary Surgery And Surgical Oncology,Baltimore, MD, USA
Introduction:
Perioperative hypothermia, defined as a patient core temperature below 36oC, has been examined for a number of surgical procedures and associated with numerous adverse outcomes among patients such as surgical site infection, cardiac arrhythmia, increased blood loss and prolonged length of stay. This work describes the implementation and efficacy of a multidisciplinary perioperative protocol to prevent hypothermia among a group of elective hepatopancreatobiliary (HPB) surgery patients at a large academic hospital.
Methods:
This work is a case-control study of 200 elective HPB surgery patients at the Johns Hopkins Hospital from 2016 to 2017, both before and after the implementation of a perioperative warming protocol. The protocol involved pre-op and operating room nurses, OR staff, anesthesia and surgery providers and consisted of applying warming blankets, assuring temperature control in the operating rooms, use of intraoperative underbody warmers and warming blankets and use of warmed IV fluids. Data was collected via retrospective chart review of the intraoperative anesthesia record and analysis was performed both with and without propensity matching to reduce standardized percentage bias.
Results:
Mean core temperature at incision time for HPB patients significantly increased in the intervention period (36.1oC ±0.4) versus the pre-intervention period (35.6oC±0.5, p<0.001). The percentage of patients achieving normothermia significantly increased at incision and in the first 2 hours of the operation (71% and 77% versus 19% and 58%, p<0.01). All of these results remained significant with propensity matching. There was no significant difference elicited in this small study for in-hospital mortality, surgical site infection, intraoperative blood loss or median hospital stay.
Conclusion:
Implementation of a multidisciplinary perioperative warming protocol significantly reduced hypothermia among elective HPB surgery patients at incision time and in the first two hours of the operation.
