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Preoperative warming and undesired surgical and anesthesia outcomes in pediatric spinal surgery-a retrospective
Matthias Görges1,2, Nicholas C West1, Wesley Cheung1,3
1Department of Anesthesiology, Pharmacology and Therapeutics, The University of British Columbia, Vancouver, BC, Canada.
Insights
Preoperative forced air warming in children undergoing spinal surgery reduced allogeneic blood transfusions but did not impact infection rates or hospital stays. Further research is needed to confirm causality.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Infection Control
Background:
- Underbody forced air warming is standard for intraoperative temperature maintenance in pediatric patients.
- Previous research indicated preoperative warming reduces intraoperative hypothermia in children undergoing spinal surgery.
Purpose of the Study:
- To assess the impact of preoperative warming on surgical site infection rates.
- To evaluate effects on hospitalization duration and blood loss (estimated blood loss, cell salvage, and allogeneic transfusions).
Main Methods:
- Retrospective chart review of 334 pediatric spinal deformity surgeries (2009-2012).
- Analysis of temperature data to identify hypothermia.
- Logistic regression and propensity score analysis adjusted for confounders.
- Multiple imputation used for missing data.
Main Results:
- Prewarming showed a trend towards reduced surgical site infections (OR 0.47, 95% CI 0.15-1.49).
- A significant reduction in allogeneic packed red blood cell transfusions was observed (OR 0.43, 95% CI 0.22-0.83).
- No significant association found for cell salvaged blood transfusion, length of hospitalization, or estimated blood loss.
Conclusions:
- Prewarming was associated with decreased allogeneic blood transfusions, though causality is not established.
- Prewarming did not demonstrate a significant effect on surgical site infections, hospitalization length, or estimated blood loss.
Background:
Underbody forced air warming is a method commonly used for intraoperative temperature maintenance in children. We previously reported that preoperative forced air warming of children undergoing spinal surgery substantially reduces the incidence and duration of intraoperative hypothermia (<36°C).
Objective:
The aim of this study was to evaluate the effects of preoperative warming before spinal deformity surgery on surgical site infection rate, length of hospitalization, and bleeding (estimated blood loss and incidence of cell salvaged and/or allogeneic packed red blood cell transfusions).
Methods:
Demographic, anesthetic, and surgical data of all patients who underwent spinal deformity surgery between December 2009 and December 2012 were obtained by retrospective chart review. Temperature data were abstracted from an existing repository; the incidence and duration of hypothermic episodes were identified. For each outcome, logistic regression models and propensity score analysis were used to estimate the effect of prewarming, adjusted for potential confounders. The issue of missing data was handled by a multiple imputation method. Data from 334 procedures were used in modeling and propensity score stratification.
Results:
Adjusted odds ratios for the effects of prewarming were 0.47 (95% CI 0.15-1.49) for surgical site infections; 0.89 (95% CI 0.55-1.41) for cell salvaged blood transfusion; 0.43 (95% CI 0.22-0.83) for allogeneic packed red blood cell transfusion; and 1.24 (95% CI 0.77-1.99) for a length of hospitalization >6 days. Adjusted mean decrease in estimated blood loss for prewarming was 72 (95% CI -29 to 173) ml.
Conclusion:
In this study, prewarming was associated with a reduction in allogeneic packed red blood cell transfusion. However, no causal relationship between prewarming and reduced allogeneic blood transfusion should be assumed. Prewarming was not associated with reductions in estimated blood loss, length of hospitalization, or the incidence of surgical site infection.
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