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Hypothermia in Total Joint Arthroplasty: A Wake-Up Call

Published:November 07, 2017DOI:https://doi.org/10.1016/j.arth.2017.10.057

      Abstract

      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.

      Level of Evidence

      Keywords

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      Linked Article

      • Letter to the Editor on “Hypothermia in Total Joint Arthroplasty: A Wake-Up Call”
        The Journal of ArthroplastyVol. 33Issue 9
        • Preview
          I read with great interest the article by Simpson et al [1] in the April 2018 issue of the journal. The authors retrospectively analyzed perioperative temperature readings from the electronic health record (EHR) of 383 patients who underwent primary total hip or knee arthroplasty with either spinal or general anesthesia. The authors concluded that, in their institution, over one-third of patients were hypothermic at the time of incision. Among other changes, they are recommending increasing ambient operating room (OR) temperature to 21°C (69.8°F) for total joint surgeries.
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