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Effectiveness of Early Warming With Self-Warming Blankets on Postoperative Hypothermia in Total Hip and Knee Arthroplasty

Koc, Baris B.; Schotanus, Martijn G. M.; Kollenburg, Jean-Paul A. P. A. C.; Janssen, Maurice J. A.; Tijssen, Fabian; Jansen, Edwin J. P.

doi: 10.1097/NOR.0000000000000383
Original Articles

BACKGROUND: Hypothermia is an important complication in joint arthroplasty. Commonly, forced air warming (FAW) devices are used intraoperatively to maintain body temperature in patients undergoing surgery. However, it is believed that these convective warming systems could increase the risk of deep surgical site infections due to disruption of unidirectional downward laminar airflow. Conductive warming devices have no noticeable effect on ventilation airflow. Nevertheless, the effectiveness of the self-warming (SW) blanket, a novel conductive warming device, on postoperative hypothermia in elective joint arthroplasty is unknown.

PURPOSE: The purpose of this study was to evaluate the effectiveness of early warming with SW blankets in the prevention of postoperative hypothermia in elective total hip (THA) and knee arthroplasty (TKA) compared with FAW devices.

METHODS: Patients who underwent elective THA or TKA between May and June 2014 were assigned in the FAW or SW group. A total of 105 patients were enrolled into the study. In the FAW group, the FAW devices were applied after disinfection of the surgical site. In the SW group, the SW blankets were already applied in the orthopaedic department. The duration of warming with SW blankets before anesthetic induction was documented. The body temperature was measured preoperatively upon arrival in the orthopaedic department and postoperatively upon arrival in the postanesthesia care unit. The patient's body temperature was measured at the tympanic membrane, and hypothermia was defined as a body temperature of less than 35.5°C.

RESULTS: The SW blankets were applied for a median of 86.8 minutes (78.8–94.8) before anesthetic induction. Postoperative hypothermia was observed in 15 (31.3%) and eight (14.0%) patients in the FAW group and the SW group, respectively (p = .029). The median postoperative body temperature was 35.59°C (35.44–35.74) and 35.95°C (35.83–36.06) in the FAW group and the SW group, respectively (p < .001).

CONCLUSION: Early warming with SW blankets was more effective than FAW devices in the prevention of postoperative hypothermia in elective THA and TKA.

Baris B. Koc, MD, Orthopaedic Resident, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands.

Martijn G. M. Schotanus, MSc, BEng, Orthopaedic Research Manager, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands.

Jean-Paul A. P. A. C. Kollenburg, MD, Orthopaedic Surgeon, Bravis Hospital, Roosendaal, the Netherlands.

Maurice J. A. Janssen, PhD, MEng, Medical Physicist, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands.

Fabian Tijssen, MD, Anesthesiologist, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands.

Edwin J. P. Jansen, MD, PhD, Orthopaedic Surgeon, Zuyderland Medical Centre, Sittard-Geleen, the Netherlands.

Baris B. Koc: Designed the study, gathered and analyzed all the data, wrote the initial draft of the manuscript, managed the study; Martijn G. M. Schotanus: Ensured the accuracy of the data and the analysis, wrote and revised the manuscript; Jean-Paul A. P. A. C. Kollenburg: Conceived the study and revised the manuscript; Maurice J. A. Janssen: Designed the study and revised the manuscript; Fabian Tijssen: Designed the study and revised the manuscript; Edwin J. P. Jansen: Conceived the study and revised the manuscript.

No conflicts of interests are declared.

© 2017 National Association of Orthopaedic Nurses