Hypothermia in Total Joint Arthroplasty: A Wake-Up Call.

Authors:
Jordan B Simpson
Jordan B Simpson
Texas Tech University Health Science Center
Lubbock | United States
Vijai S Thomas
Vijai S Thomas
Institute of Orthopedic Research and Education
Sabir K Ismaily
Sabir K Ismaily
Institute of Orthopedic Research and Education
United States
Pavel I Muradov
Pavel I Muradov
Outpatient Center
Philip C Noble
Philip C Noble
Institute of Orthopedic Research and Education
United States
Stephen J Incavo
Stephen J Incavo
Houston Methodist Hospital
Houston | United States

J Arthroplasty 2018 04 8;33(4):1012-1018. Epub 2017 Nov 8.

Houston Methodist Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas.

Background: Total joint patients are particularly vulnerable to perioperative hypothermia (PH) (combined effects of anesthesia, radiation, and convective heat loss from exposed skin surfaces and cool temperatures in the operating room). There are limited studies on PH in these patients.

Methods: In a retrospective review of 204 patients undergoing primary hip and 179 undergoing primary knee replacement surgeries, time and temperature parameters were collected from the electronic health records from preoperative and postoperative recovery room nursing assessments, intraoperative anesthesia records, and floor nursing notes. Basic patient demographic data was recorded. Chi-squared and paired t-tests were used to compare between hypothermic and normothermic groups.

Results: At the time of incision, 60 of 179 (34%) total knee arthroplasty (TKA) patients and 80 of 204 (39%) total hip arthroplasty (THA) patients were hypothermic. In THA patients, 65% remained hypothermic for the duration of anesthesia compared to 33% of TKA patients. The largest drop in core body temperature in both THA and TKA patients occurred between preoperative holding and induction of anesthesia. In THA patients, spinal anesthesia had a significantly higher occurrence of PH. No significant patient factor was found to increase risk.

Conclusion: Emphasis on preoperative holding protocols, decreasing time from operating room entry to incision, and increasing ambient room temperature could reduce risk of hypothermia in total joint replacement patients.

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http://dx.doi.org/10.1016/j.arth.2017.10.057DOI Listing

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April 2018
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