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A standardized protocol to reduce preoperative hypothermia in pediatric spinal fusion surgery: a quality improvement
Insights
A new warming protocol significantly reduced hypothermia in pediatric spine surgery patients. This intervention improved patient temperature during surgery without adverse events, enhancing safety and recovery.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Patient Safety
Background:
- Hypothermia in adult surgical patients is linked to adverse outcomes like infections and increased costs.
- Pediatric surgical patients, especially during spine surgery, face higher hypothermia risks due to physiological factors and surgical conditions.
Purpose of the Study:
- To implement and evaluate a quality improvement initiative aimed at reducing hypothermia duration in pediatric patients undergoing spine surgery.
Main Methods:
- A retrospective analysis of 162 pediatric patients undergoing spinal deformity surgery.
- Temperature data collected perioperatively before and after implementing a preoperative warming protocol.
Main Results:
- The preoperative warming protocol increased average incision temperature from 34.0°C to 35.3°C (p=0.001).
- No complications such as burns, hyperthermia, or arrhythmias were observed.
Conclusions:
- Preoperative warming and active normothermia management effectively reduce hypothermia incidence and duration in pediatric spine surgery.
- The warming protocol was safe and well-tolerated, with no adverse events reported.
Objective:
Hypothermia in adult surgical patients has been correlated with an increase in the occurrence of surgical site wound infections, increased bleeding, slower recovery from anesthetics, prolonged hospitalization, and increased healthcare costs. Pediatric surgical patients are at potentially increased risk for hypothermia because of their smaller body size, limited stores of subcutaneous fat, and less effective regulatory capacity. This risk is exacerbated during pediatric spinal surgery by lower preoperative temperature, increased surface exposure to cold during induction and positioning, and prolonged surgical procedure times. The purpose of this quality improvement initiative was to reduce the duration of hypothermia for pediatric patients undergoing spine surgery.
Methods:
Demographic and clinical data were collected on 162 patients who underwent spinal deformity surgery between October 1, 2017, and July 31, 2019. Data points included patient age, gender, diagnosis, surgical procedure, and temperature readings throughout different phases of perioperative care. Temperatures were obtained upon arrival to the day of surgery, upon presentation to the operating room, during prone positioning, at incision, and at the end of the procedure. Twelve patients were analyzed prior to implementation of a protocol, while 150 patients composed the post-protocol group.
Results:
Using descriptive statistics, the authors found that the average body temperature at the time of incision was 34.0°C prior to the adoption of a preoperative warming protocol, and 35.3°C following a preoperative warming protocol (p = 0.001). There were no complications, such as burns, hyperthermia, or arrhythmias, related to preoperative warming of patients.
Conclusions:
The placement of a warming blanket on the bed prior to patient arrival and actively targeting normothermia reduced the incidence and duration of hypothermia in pediatric patients undergoing spine surgery with no adverse events.
