| Abstract: | Objective Hypothermia is a common problem in surgical procedures. Statistics show that approximately 50%–90% of patients experience perioperative hypothermia during surgery (namely the core temperature °C). Hypothermia increases the risk of wound infection and myocardial ischemia, hampers the normal operations of the respiratory system, causes coagulation disorders, and prolongs the postoperative recovery time. This study investigated the causes of intraoperative hypothermia, the influence of hypothermia on postoperative recovery.
Methods This study was a retrospective study on patients who received spine surgeries under general anesthesia in a medical center in Central Taiwan from January 2013 to December 2014. Logistic regression and linear multiple regression statistical analysis models were then adopted to investigate factors (demographic characteristics, health conditions, operative factors, analgesic factors, environmental factors, and warmed intervention) that had a significant correlation with hypothermia occurrence, postanesthesia recovery room of length of stay, and total hospital length of stay.
Results In total, 476 patients were recruited. The incidence of hypothermia for patients receiving spinal surgeries was 58.4%. Patients whose duration of surgery was >180 min had a higher incidence of hypothermia than those whose duration of surgery was ≤180 min. Each 1°C increase in body temperature after induction reduced hypothermia incidence by 91.1%. Each one unit increase in packed red blood cells (RBCs) enhanced hypothermia incidence by 27%. Each 1°C increase in temperature of the operating room(OR) lowered the incidence of hypothermia by 91.6%. Patients who used warmed IV fluid, a warmed forced-air device, or were covered by cotton padding had 0.29, 0.17, and 0.12 times the probability of hypothermia incidence, respectively, than those who did not receive these measures. The postanesthesia recovery room(POR) length of stay of male was 12.5 min shorter than that of female. The POR length of stay of patients who received a blood transfusion was 23.6 min longer than those who did not receive a blood transfusion; specifically, each 1 u increase of whole blood transfusion enhanced the POR length of stay by 26.6 min. Each 1°C increase in body temperature 30 min before operation termination reduced the POR length of stay by 11.8 min. The hospital length of stay (LOS)increased with age. The hospital LOS was prolonged with increases in the intraoperative dosage of Atracuriumn. Each 500 ml increase in intraoperative blood loss prolonged the hospital LOS by 0.5 days. Each 1°C increase in the body temperature after 2 hours of anesthesia induction decreased the hospital LOS by 0.6 days. Patients with a postoperative wound infection had 11 days longer hospital LOS than those without infection.
Conclusion The incidence of hypothermia increased with age and duration of surgery. The duration of surgery, dosage of Cisatracurium (Muscle relaxant), body temperature after anesthesia induction, RBC transfusion volume, OR temperature , and warmed intervention were the influencing factors of intraoperative hypothermia. Gender, blood transfusion, whole blood, extubation, total IV volume, Atracuriumn dosage, and the body temperature 30 min before operation termination were the influencing factors of POR length of stay. In addition, influencing factors of hospital LOS comprised age, Atracuriumn dosage, heart rate before anesthesia induction, body temperature after 2 hours of anesthesia induction, infection, and blood loss. |
