Incidence of perioperative inadvertent hypothermia and compliance with evidence-based recommendations at four Australian hospitals

BACKGROUND: Perioperative inadvertent hypothermia significantly increases a patient's risk of adverse complications such as surgical site infection; morbid cardiac events; and surgical bleeding (1, 2). Perioperative inadvertent hypothermia is preventable and guidelines exist which synthesise research findings into evidence-based recommendations (1). Although the recommendations are relatively simple and inexpensive they are often not adhered to in clinical practice. Up to 70% of patients will experience hypothermia postoperatively when recommended prevention practices are not implemented (3-6).

METHOD: A retrospective audit of 400 patients was conducted to identify the incidence of perioperative inadvertent hypothermia and compliance with evidence-based recommendations at four Australian hospitals. Patients were excluded from the audit if they were pregnant, under 18yrs, had impaired thermoregulation, therapeutic hypothermia, or local anaesthesia only. Trained auditors extracted data on the incidence of perioperative inadvertent hypothermia, compliance with evidence-based recommendations, and patient characteristics.

RESULTS: 350 patients met the inclusion criteria. The mean age of patients was 56 (SD 19). The majority (74%, n= 260) had elective surgery with orthopaedic procedures the most common surgical type (28%, n=98). The incidence of perioperative inadvertent hypothermia in the population was 32% (n=101) and the lowest recorded temperature was 34.0°C. 80% (n=280) of patients did not have a temperature documented intraoperatively and only 8.8% (n=29) had at least one documented temperature for each perioperative phase (pre, intra, and postoperative). 45% (n=133) of intraoperative patients and 77% (n=97) of postoperative patients did not receive active warming when indicated. Contrary to recommended practice, 47% (n=137) of patients were hypothermic at discharge from the Post Anaesthetic Recovery Unit.

CONCLUSION: This audit revealed poor compliance with evidence-based recommendations which may have contributed to the significant number of patients who experienced perioperative inadvertent hypothermia. Further research should be undertaken to identify mitigating strategies to overcome barriers to evidence-based perioperative hypothermia prevention.