Preventing hypothermia in total hip and knee arthroplasty: A prewarming initiative

Despite our advanced knowledge of thermoregulation, impact of perioperative hypothermia (PH), and hypothermia prevention modalities, 43% of patients receiving total joint replacement experience PH. The purpose of this article is to describe the impact of implementing a prewarming bundle to decrease perioperative hypothermia in patients undergoing general anesthesia for total joint replacement surgery.

Anesthetics inhibit natural physiological defense mechanisms against hypothermia. Consequently, PH occurs in 50-90% of patients undergoing general anesthesia. Advanced age, length of surgery, and prolonged skin exposure make patients receiving total joint replacement surgery particularly vulnerable to hypothermia. Evidence indicates that prewarming decreases the incidence of PH but is not common practice.

The prewarming bundle included provider training, implementation of a prewarming intervention process, and consistent core temperature monitoring throughout the perioperative phases. Utilizing a forced air warming (FAW) gown, patients were prewarmed in the preoperative area, the block installation area, or upon arrival to the operating room before anesthesia induction.

Prewarming the patient with a FAW for a minimum of 10 min prior to anesthetic induction effectively reduced perioperative hypothermia by up to 48% in patients receiving anesthesia for joint replacement.

Assimilating a prewarming bundle into the perioperative workflow for total joint surgery care promotes adequate thermoregulation and reduces the incidence of perioperative hypothermia.