Intraoperative hypothermia and its clinical outcomes in patients undergoing general anesthesia: National study in China

PLoS One. 2017 Jun 8;12(6):e0177221. doi: 10.1371/journal.pone.0177221. eCollection 2017.

Abstract

Background/objective: Inadvertent intraoperative hypothermia (core temperature <36°C) is a frequently preventable complication with several adverse consequences. Our study aimed to determine the overall incidence of inadvertent intraoperative hypothermia and its risk factors associated with clinical outcomes in this national survey in China.

Methods: We conducted a national cross-sectional study with 30 days postoperative follow-up from November 2014 through August 2015. A total of 3132 eligible patients underwent general anesthesia were randomly selected from 28 hospitals in the nationwide of China.

Results: The overall incidence of intraoperative hypothermia was as high as 44.3%, in which cumulative incidence rates of hypothermia being 17.8%, 36.2%, 42.5% and 44.1% within 1 h, 2 h, 3 h and 4 h respectively following induction of anesthesia. All patients were warmed passively by covering of surgical draping, sheets or cotton blankets, whereas only 14.2% of patients received active warming with space heaters or electric heater or electronic blankets. Compared to normothermic patients, patients with hypothermia is associated with more postoperative ICU admit, longer PACU and more postoperative hospital days, but no difference in surgical site infection (SSI) rates or 30-day mortality. Several factors were shown to be associated with decreased risk of hypothermia. They are active warming (OR = 0.46, 95% CI 0.26-0.81), BMI ≥ 25 (OR = 0.54, 95% CI 0.45-0.65), higher baseline core temperature (OR = 0.04, 95% CI 0.03-0.06), and higher ambient temperature (OR = 0.83, 95% CI 0.78-0.88). Risk factors associated with an increased risk of hypothermia included major-plus surgery (OR = 1.49, 95% CI 1.23-1.79), and long anesthesia (>2 h) (OR = 2.60, 95% CI 2.09-3.24).

Conclusions: The incidence of intraoperative hypothermia in China is high, and the rate of active warming of patients during operation is low. Hypothermia is associated with more postoperative shivering, increased ICU admissions, and longer postoperative hospital days.

MeSH terms

  • Anesthesia, General / adverse effects*
  • China
  • Demography
  • Humans
  • Hypothermia / epidemiology
  • Hypothermia / etiology*
  • Incidence
  • Intraoperative Care
  • Middle Aged
  • Risk Factors
  • Treatment Outcome

Grants and funding

This study was funded by three separate grants: China National Health and Planned Parenthood Committee Health Quality Improvement Award (ID# 201402017, principle investigator Yuguang Huang, MD), China National Nature Science Foundation (Grant # 31070930, principle investigator Yuguang Huang, MD), and an unrestricted research grant (MDI0091, principal investigator Yuguang Huang, MD) from 3M China. However, none of these grants provided salary support to any of the investigators. These grants were for IRB review, investigator meeting and CRO (study monitoring, data management, statistical analysis and report etc.), travel, national or international conference and publication.