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Perioperative body temperature maintenance and occurrence of surgical site infection: A systematic review with meta-analysis

Published:February 10, 2020DOI:https://doi.org/10.1016/j.ajic.2020.01.002

      Highlights

      • Perioperative body temperature maintenance has been associated with preventing surgical site infection.
      • Active warming methods are effective to maintain perioperative body temperature.
      • The available scientific evidence is insufficient to clarify the benefits of warming methods in preventing surgical site infection.

      Background

      Current guidelines recommend perioperative warming as one of the strategies to prevent surgical site infection, although there are gaps in the knowledge produced on this issue.

      Aim

      Assess the efficacy of active warming methods to maintain perioperative patients’ body temperature and its effect on the occurrence of surgical site infection.

      Methods

      A systematic review with meta-analysis was carried out. PubMed, CINAHL, LiLACS, CENTRAL, and EMBASE databases were searched.

      Findings

      Of the 956 publications identified, 9 studies were selected for quantitative synthesis and 6 for the meta-analysis. The forced-air warming system was investigated in 8 studies. The generated evidence indicated that the use of an active warming method could maintain higher average body temperature as well as could decrease the surgical site infection incidence. Exposure of the patient to temperatures below 36°C in the perioperative period increased the chances of developing this type of infection. The meta-analysis indicated that the association between perioperative active warming methods compared with others to reduce the chances of developing surgical site infection remains unclear (odds ratio = e−3.59 = 2.718−0.59 = 0.552, 95% confidence interval (odds ratio) = (0.269-1.135), P = 0.106 I2 = 54.34%).

      Conclusions

      The employment of an active warming method is effective to maintain higher averages of body temperature. However, more randomized clinical trials are needed to assess the efficacy of that intervention to prevent surgical site infection.

      Key Words

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      References

        • Association of Perioperative Registered Nurses
        Recommended practices for the prevention of unplanned perioperative hypothermia.
        in: Perioperative Standards and Recommended Practices. AORN, Inc., Denver2017: 567-590
        • Hooper VD
        • Chard R
        • Clifford T
        • et al.
        ASPAN's evidence-based clinical practice guideline for the promotion of perioperative normothermia: second edition.
        J Perianesth Nurs. 2010; 25: 346-365
        • Jeyadoss J
        • Thiruvenkatarajan V
        • Watts RW
        • Sullivan T
        • van Wijk RM
        Intraoperative hypothermia is associated with an increased intensive care unit length-of-stay in patients undergoing elective open abdominal aortic aneurysm surgery: a retrospective cohort study.
        Anaesth Intensive Care. 2013; 41: 759-764
        • Wagner VD
        Unplanned perioperative hypothermia.
        AORN J. 2006; 83 (470, 473-476)
        • Flores-Maldonado A
        • Medina-Escobedo CE
        • Ríos-Rodríguez HM
        • Fernández-Domínguez R
        Mild perioperative hypothermia and the risk of wound infection.
        Arch Med Res. 2001; 32: 227-231
        • McAnally HB
        • Cutter GR
        • Ruttenber AJ
        • Clarke D
        • Todd JK
        Hypothermia as a risk factor for pediatric cardiothoracic surgical site infection.
        Pediatr Infect Dis J. 2001; 20: 459-462
        • Melling AC
        • Ali B
        • Scott EM
        • Leaper DJ
        Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial.
        The Lancet. 2001; 358: 876-880
        • Doufas AG
        Consequences of inadvertent perioperative hypothermia.
        Best Pract Res Clin Anaesthesiol. 2003; 17: 535-549
        • Kurz A
        • Sessler DI
        • Lenhardt R
        Perioperative normothermia to reduce the incidence of surgical wound infection and shorten hospitalization.
        N Engl J Med. 1996; 334: 1209-1215
        • Beilin B
        • Shavit Y
        • Razumovsky J
        • Wolloch Y
        • Zeidel A
        • Bessler H
        Effects of mild perioperative hypothermia on cellular immune responses.
        Anesthesiology. 1998; 89: 1133-1140
        • Kurz A
        Thermal care in the perioperative period.
        Best Pract Res Clin Anaesthesiol. 2008; 22: 39-62
        • Kirby JP
        • Mazuski JE
        Prevention of surgical site infection.
        Surg Clin North Am. 2009; 89: 365-389
        • Madrid E
        • Urrútia G
        • Roqué i Figuls M
        • et al.
        Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults.
        Cochrane Database Syst Rev. 2016; 4CD009016
      1. Global Guidelines for the Prevention of Surgical Site Infection.
        2nd ed. World Health Organization, Geneva2018 (Licence: CC BY-NC-SA 3.0 IGO)
        • Ban KA
        • Minei JP
        • Laronga C
        • et al.
        American College of Surgeons and Surgical Infection Society: Surgical Site Infection Guidelines, 2016 Update.
        J Am Coll Surg. 2017; 224: 59-74
        • Berríos-Torres SI
        • Umscheid CA
        • Bratzler DW
        • et al.
        Centers for Disease Control and Prevention Guideline for the Prevention of Surgical Site Infection, 2017.
        JAMA Surg. 2017; 152: 784-791
        • Association for Professionals in Infection Control and Epidemiology
        APIC Implementation Guide: Infection Preventionist's Guide to the OR.
        APIC, USA2018
        • Itani KMF
        • Dellinger EP
        • Mazuski J
        • et al.
        Surgical Site Infection Research Opportunities.
        Surg Infect (Larchmt). 2017; 18: 401-408
        • Anderson DJ
        • Podgorny K
        • Berríos-Torres SI
        • et al.
        Strategies to prevent surgical site infections in acute care hospitals: 2014 update.
        Infect Control Hosp Epidemiol. 2014; 35: 605-627
        • Burns SM
        • Piotrowski K
        • Caraffa G
        • Wojnakowski M
        Incidence of postoperative hypothermia and the relationship to clinical variables.
        J Perianesth Nurs. 2010; 25: 286-289
        • Liberati A
        • Altman DG
        • Tetzlaff J
        • et al.
        The PRISMA statement for reporting systematic reviews and metanalyses of studies that evaluate health care interventions: explanation and elaboration.
        BMJ. 2009; 6e1000100
        • Higgins JP
        • Altman DG
        • Gøtzsche PC
        • et al.
        The Cochrane Collaboration's tool for assessing risk of bias in randomised trials.
        BMJ. 2011; 343: d5928
        • Guyatt GH
        • Busse JW
        Modification of Cochrane Tool to Assess Risk of Bias in Randomized Trials.
        GROWTH, Santa Monica (CA)2016
      2. Wells GA, Shea B, O'Connell D et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomized studies in meta-analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.htm. Accessed October 18, 2018.

        • Yi J
        • Liang H
        • Song R
        • Xia H
        • Huang Y
        Maintaining intraoperative normothermia reduces blood loss in patients undergoingmajor operations: a pilot randomized controlled clinical trial.
        BMC Anesthesiol. 2018; 18: 126
        • Brown MJ
        • Curry TB
        • Hyder JA
        • et al.
        Intraoperative hypothermia and surgical site infections in patients with class I/clean wounds: a case-control study.
        J Am Coll Surg. 2017; 224: 160-171
        • Seamon MJ
        • Wobb J
        • Gaughan JP
        • Kulp H
        • Kamel I
        • Dempsey DT
        The effects of intraoperative hypothermia on surgical site infection: an analysis of 524 trauma laparotomies.
        Ann Surg. 2012; 255: 789-795
        • Grant EN
        • Craig MG
        • Tao W
        • McIntire DD
        • Leveno KJ
        Active warming during cesarean delivery: should we SCIP it?.
        Am J Perinatol. 2015; 32: 933-938
        • Baucom RB
        • Phillips SE
        • Ehrenfeld JM
        • et al.
        Association of perioperative hypothermia during colectomy with surgical site infection.
        JAMA Surg. 2015; 150: 570-575
        • Wong PF
        • Kumar S
        • Bohra A
        • Whetter D
        • Leaper DJ
        Randomized clinical trial of perioperative systemic warming in major elective abdominal surgery.
        Br J Surg. 2007; 94: 421-426
        • Lau A
        • Lowlaavar N
        • Cooke EM
        • et al.
        Effect of preoperative warming on intraoperative hypothermia: a randomized-controlled trial.
        Can J Anaesth. 2018; 65: 1029-1040
        • Lenhardt R
        The effect of anesthesia on body temperature control.
        Front Biosci (Schol Ed). 2010; 2: 1145-1154
        • Sessler DI
        Perioperative thermoregulation and heat balance.
        Lancet. 2016; 387: 2655-2664
        • Kumar S
        • Wong PF
        • Melling AC
        • Leaper DJ
        Effects of perioperative hypothermia and warming in surgical practice.
        Int Wound J. 2005; 2: 193-204
        • Camus Y
        • Delva E
        • Sessler DI
        • Lienhart A
        Pre-induction skin-surface warming minimizes intraoperative core hypothermia.
        J Clin Anesth. 1995; 7: 384-388
        • Stevens D
        • Johnson M
        • Langdon R
        Comparison of two warming interventions in surgical patients with mild and moderate hypothermia.
        Int J Nurs Pract. 2000; 6: 268-275
        • Horn EP
        • Schroeder F
        • Gottschalk A
        • et al.
        Active warming during cesarean delivery.
        Anesth Analg. 2002; 94: 409-414
        • Campbell G
        • Alderson P
        • Smith AF
        • Warttig S
        Warming of intravenous and irrigation fluids for preventing inadvertent perioperative hypothermia.
        Cochrane Database Syst Rev. 2015; 4CD009891
        • Poveda VB
        • Galvão CM
        • Dantas RAS
        Hipotermia no período intra-operatório em pacientes submetidos a cirurgias eletivas.
        Acta Paul Enferm. 2009; 22: 361-366
        • Wetz AJ
        • Perl T
        • Brandes IF
        • Harden M
        • Bauer M
        • Bräuer A
        Unexpectedly high incidence of hypothermia before induction of anesthesia in elective surgical patients.
        J Clin Anesth. 2016; 34: 282-289
        • Poveda VB
        • Nascimento AS
        The effect of intraoperative hypothermia upon blood transfusion needs and length of stay among gastrointestinal system cancer surgery.
        Eur J Cancer Care (Engl). 2017; 26: e12688
        • Umscheid CA
        • Mitchell MD
        • Doshi JA
        • Agarwal R
        • Williams K
        • Brennan PJ
        Estimating the proportion of healthcare associated infections that are reasonably preventable and the related mortality and costs.
        Infect Control Hosp Epidemiol. 2011; 32: 101-114
        • Spruce L
        Back to basics: preventing surgical site infections.
        AORN J. 2014; 99: 600-611
        • Love KL
        Patient care interventions to reduce the risk of surgical site infections.
        AORN J. 2016; 104: 506-515
        • O'Hara LM
        • Thom KA
        • Preas MA
        Update to the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee Guideline for the Prevention of Surgical Site Infection (2017): a summary, review, and strategies for implementation.
        Am J Infect Control. 2018; 46: 602-609