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Preventing perioperative hypothermia in children through implementation of customised guidelines
Shu Ying Lee1, Rehena Sultana2, John Carson Allen2
1Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, Singapore.
Insights
Customised guidelines significantly reduced perioperative hypothermia (PH) in paediatric surgical patients. However, the effectiveness of these guidelines was diminished when continuous core temperature monitoring sensors incurred costs for patients.
Area of Science:
- Pediatric Anesthesiology
- Patient Safety
- Clinical Guideline Development
Background:
- Perioperative hypothermia (PH) is a prevalent complication in pediatric surgery, linked to adverse outcomes.
- Existing PH prevention guidelines are primarily designed for adults and exhibit institutional variability.
- There is a need to assess the efficacy of tailored guidelines for pediatric populations.
Purpose of the Study:
- To evaluate the effectiveness of customized guidelines in reducing PH in pediatric surgical patients.
- To analyze the influence of cost considerations on physician adherence to temperature management practices.
- To assess the impact of continuous core temperature monitoring sensors on PH incidence.
Main Methods:
- Prospective cohort study involving 3917 pediatric patients (≤16 years) undergoing general anesthesia.
- Data collected across four phases: standard management (Phases 1-2) and guideline implementation (Phases 3-4).
- Continuous core temperature monitoring sensors were provided free in Phases 1 & 3, and charged in Phases 2 & 4. PH defined as core temperature <36°C.
Main Results:
- Guidelines implementation reduced PH incidence from 11.0% to 6.79% (OR 0.63, P=0.0002).
- Free sensors increased the detection of PH (OR 1.48, P=0.001).
- The reduction in PH was more pronounced with free sensors alongside guidelines (OR 0.64) compared to charged sensors (OR 0.75).
Conclusions:
- Customized guidelines effectively reduced perioperative hypothermia in pediatric surgical patients.
- The positive impact of guidelines on reducing PH was attenuated by cost-related factors associated with monitoring sensors.
- Implementing cost-effective strategies is crucial for maximizing the benefits of clinical guidelines in pediatric care.
Introduction:
Perioperative hypothermia (PH) is common in children and associated with adverse clinical outcomes. Guidelines to prevent PH are mainly developed for adults and differ among institutions. We aimed to evaluate the effectiveness of customised guidelines in reducing PH in our paediatric population and the impact of cost considerations on physician practice.
Methods:
Patients aged ≤16 years undergoing general anaesthesia in our tertiary paediatric hospital were prospectively recruited in this cohort study. Patient demographics, surgical procedures, anaesthesia details and temperature control measures were recorded. Data collection occurred over four phases: Phases 1 and 2 comprised standard management, while Phases 3 and 4 occurred following guidelines implementation. Sensors for continuous core temperature monitoring were provided free to patients during Phases 1 and 3, but were charged during Phases 2 and 4. The main outcome was occurrence of PH, defined as core temperature <36°C at any point from induction of anaesthesia to discharge from the postanaesthetic care unit. The impact of guidelines implementation and cost considerations influencing physician practice on PH outcomes was also analysed.
Results:
Data from 3917 patients was analysed (1766 in Phase 1, 679 in Phase 2, 706 in Phase 3 and 766 in Phase 4). Guidelines implementation decreased PH incidence from 11.0% to 6.79% (odds ratio [OR] 0.63, 95% confidence interval [CI] 0.50-0.80, P = 0.0002). Free sensors increased the odds of detecting PH (OR 1.48, 95% CI 1.17-1.88, P = 0.001). With guidelines implementation, there was greater reduction in PH with free sensors (OR 0.64, 95% CI 0.47-0.88, P = 0.0055) compared to chargeable sensors (OR 0.75, 95% CI 0.50-1.11, P = 0.1471).
Conclusions:
Customised guidelines facilitated a sustained reduction of hypothermia in our paediatric surgical patients, although its impact was reduced by cost considerations.
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