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QUALITY OF CARE IMPACT
Every surgical patient is at risk for perioperative hypothermia. Unplanned, mild perioperative hypothermia increases the cost care for each patient $2,500 - $7,000.(1) Maintaining normothermia during surgery is becoming the community standard of care. (2) We’re now in a period of intense Outcome Measurement, Risk Management and Best Practices implementation. For example, the CMS & CDC’s nationwide Surgical Care Improvement Project seeks to reduce four costly surgical complications 25% by the year 2010. The maintenance of surgical patient temperature is a core recommendation in helping to reduce costly complications because of the deleterious impact of even mild hypothermia on outcomes.

Adverse Myocardial Outcomes: Myocardial infarctions are the leading cause of unexpected death after otherwise routine surgery…a major adverse effect of mild hypothermia is a tripling of the rate of morbid myocardial events.(3)

Loss of Blood & Transfusion Requirement: A second major consequence of mild hypothermia is coagulopathy…mild hypothermia has been shown to increase blood loss(4) and augment the requirement for allogeneic blood transfusions. It also significantly increased the requirement for allogeneic blood transfusion.(5)

Wound Infections: Wound Infections: Patients who had a decrease of only 1.9°C in core temperature were 64% more likely to develop surgical wound infections as were those in whom a normal body temperature of 37°C was maintained.(6)

Increased Length of Stay: The duration of hospitalization was 20% longer for patients with hypothermia…This prolongation remained highly statistically significant even when the analysis was restricted to uninfected patients.(7) It’s been reported that each SSI adds approximately 7.3 days to a patient’s stay.

Shorter Procedures & Patient Satisfaction: Thermal discomfort is naturally less important than are morbid cardiac outcomes or coagulopathy. However, it is a consequence that patients take seriously. Patients, asked years after surgery, often identify feeling cold in the immediate postoperative period the worst part of their hospitalization -- sometimes rating it worse than surgical pain.(8) Younger patients are more likely to shiver and are also likely to find a given degree of hypothermia more uncomfortable because their behavioral regulation is better preserved.(9)

1- Mahoney CB and Odom, J. “Maintaining Intraoperative Normothermia: A Meta-Analysis of Outcomes with Costs.” American Assoc of Nurse Anesthetists Journal. March/April, 1999

2- Sessler DI, Akca O, Nonpharmocological Prevention of Surgical Wound Infections. Healthcare Epidemiology CID 2002:35; 1397-1404 (1 December)

3- Sessler DI, Akca O, Nonpharmocological Prevention of Surgical Wound Infections. Healthcare Epidemiology CID 2002:35; 1397-1404 (1 December)

4- Carli F, Emery PW, Freemantle CAJ. Effect of peroperative normothermia on postoperative protein metabolism in elderly patients undergoing hip arthroplasty. Br J Anaesth 1989; 63:276–82.

5- Sessler DI, Akca O, Nonpharmocological Prevention of Surgical Wound Infections. Healthcare Epidemiology CID 2002:35; 1397-1404 (1 December)

6- Kurz A, Sessler DI, Lenhardt RA. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization.
N Engl J Med 1996; 334:1209–15.

7- Sessler DI, Akca O, Nonpharmocological Prevention of Surgical Wound Infections. Healthcare Epidemiology CID 2002:35; 1397-1404 (1 December)

8- http//or.org/ consequences of perioperative hypothermia-recovery & comfort

9- Sessler DI, Akca O, Nonpharmocological Prevention of Surgical Wound Infections. Healthcare Epidemiology CID 2002:35; 1397-1404 (1 December)

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