Background
Post-operative hypothermia is a predisposing factor of surgical complications. Pre-operative warming for ≥ 10 minutes may reduce post-operative hypothermia. This CQI project aimed to identify the risks factors for post-operative hypothermia, evaluate the effectiveness of pre-operative warming and promote implementation of appropriate corporate practice in the perioperative nursing specialty.
Methodology
Eighteen operating theatres in 17 hospitals joined the project. Pre-operative warming was implemented in November 2019. Adult patients undergoing elective colorectal, urological and thoracic surgeries with general or spinal anaesthesia were warmed for ≥ 10 minutes pre-operatively. A control group consisting of similar patients in November 2018 was used.
Results
Nine hundred sixteen patients in November 2019 and 996 in November 2018 were recruited. It was subsequently found that 4 out of the 18 operating theatres had the same pre-operative warming protocol implemented in November 2018. Therefore, 373 patients from these 4 operating theatres were grouped into the implementation group. Univariate analysis revealed implementation of pre-operative warming, male gender, age ˃ 70, body mass index (BMI) ≤ 23 and blood loss > 300ml significantly associated with post-operative hypothermia. As there were substantial missing data in BMI and blood loss, they were not included in the subsequent multivariate analysis. Consequently, implementation of pre-operative warming, male gender and age > 70 were found to be independent factors that affected the incidence of post-operative hypothermia. A subgroup analysis of the patients operated in November 2019 showed pre-operative warming performance was also an independent factor that could reduce post-operative hypothermia. The benefit of pre-operative warming was most obvious in urology cases.
Conclusion
Male gender and age > 70 were risk factors for post-operative hypothermia. Implementation and performance of pre-operative warming reduced post-operative hypothermia. The benefit of pre-operative warming was most obvious in urology cases. The findings were subsequently used to formulate our first Specialty Nursing Practice Guideline in Maintenance of Perioperative Normothermia.
