Drs. Christina Stuart and Robert Meguid, recently published findings of a retrospective cohort study evaluating the incidence and consequences of incidental perioperative hypothermia exposure in the thoracic surgery population. They found that more than 90% of patients undergoing robotic-assisted thoracic surgery lung resections experience some degree of inadvertent perioperative hypothermia and that patients that developed hypothermia had associated increased rates of 30-day morbidity and infectious complications. Based on these data, Drs. Stuart and Meguid were awarded an IHQSE Clinical Effectiveness and Patient Safety grant to study structured and interval-specific interventions aimed at decreasing rates of inadvertent perioperative hypothermia and subsequent complications. This interventional study concluded in June of 2024 and the results are being analyzed.

Tell us about your approach to this project?

The idea for this project arose during our development and auditing of our Thoracic Enhanced Recovery After Surgery (ERAS) protocol. The European Society of Thoracic Surgeons and ERAS society recommend “maintenance of normothermia” as a key goal metric of ERAS pathways. During our quarterly review of our multi-institutional ERAS data, we noted that some of patients were not meeting this goal. We evaluated several years of perioperative data and noted that patients who developed perioperative hypothermia had worse surgical outcomes compared to those who didn’t. Our discrete temperature data helped us understand where patients are losing the most heat and in what phases of care we can intervene. Based on these data we developed a protocol to keep patients warm throughout the entire course of their care, including in the preprocedural area, in the operating room (OR), and in the recovery room. In developing these interventions we gathered the support of hospital stakeholders and OR administrative staff. We engaged the perioperative nursing staff, surveying them on knowledge, attitudes and practices regarding prevention of perioperative hypothermia. This was an important step in identifying any potential barriers to these interventions, and helped streamline implementation.


Why is this work important?

Perioperative hypothermia (core temperature <36˚C) has been linked to poor surgical outcomes, including increased incidence of postoperative infection, delayed surgical wound healing, alteration of clotting functions, impairment of immune function, and mortality. These complications contribute to longer hospital length of stay and increased healthcare costs. Our interval-specific data provide insight into where patients experience the most temperature loss, and thus, where interventions to reduce perioperative hypothermia may provide the most benefit. Our data supports temperature loss of 0.6˚C between entering the OR and anesthesia induction suggesting that the pre-procedure and pre-induction intervals may provide opportunities to prevent hypothermia.


How do you think this will impact healthcare?

We hope that our interventions ultimately reduce intraoperative hypothermia and improve patient outcomes, which lead to improved patient experience and lessened burden on the healthcare system including decreased length of stay and healthcare costs.

Read the full publication in the Journal of Thoracic and Cardiovascular Surgery here.