Clinical events after hip fracture surgery: the ESCORTE study (original) (raw)
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Perioperative hypothermia during hip fracture surgery: An observational study
Journal of Evaluation in Clinical Practice, 2017
RationaleElderly patients are at high risk of accidental perioperative hypothermia. The primary objective of this study was to measure the changes in body temperature and the incidence of hypothermia in elderly patients undergoing hip fracture surgery.MethodsWe conducted a prospective observational study on all adult patients undergoing surgery for fractured neck of femur between December 2013 and July 2014. We monitored their temperatures in different perioperative areas at multiple time points and also noted the warming methods used.ResultsEighty‐seven patients were included in this study. A significant drop in body temperature (0.7°C, 95% CI: 0.6‐0.9, P < 0.001) occurred from their arrival at the operating theatre until their arrival at the recovery room. A significant drop of 0.2°C (95% CI: 0.1‐0.4, P < 0.001) was observed at the holding bay area. One third of the patients were noted to be hypothermic when they arrived at the recovery room.ConclusionThese results indicate ...
The American Journal of Surgery, 2004
Generally, hypothermia is defined as a core temperature Ͻ35°C. In elective surgery, induced hypothermia has beneficial effects. It is recommended to diminish complications attributable to ischemia reperfusion injury. Experimental studies have shown that hypothermia during hemorrhagic shock has beneficial effects on outcome. In contrast, clinical experience with hypothermia in trauma patients has shown accidental hypothermia to be a cause of posttraumatic complications. The different etiology of hypothermia might be one reason for this disparity because induced therapeutic hypothermia, with induction of poikilothermia and shivering prevention, is quite different from accidental hypothermia, which results in physiological stress. Other studies have shown evidence that this contradictory effect is related to the plasma concentration of high-energy phosphates (e.g., adenosine triphosphate [ATP]). Induced hypothermia preserves ATP storage, whereas accidental hypothermia causes depletion. Hypothermia also has an impact on the immunologic response after trauma and elective surgery by decreasing the inflammatory response. This might have a beneficial effect on outcome. Nevertheless, posttraumatic infectious complications may be higher because of an immunosuppressive profile. Further studies are needed to investigate the impact of induced hypothermia on outcome in trauma patients.
Too Cool? Hip Fracture Care and Maintaining Body Temperature
Geriatric Orthopaedic Surgery & Rehabilitation
Introduction: Patients with hip fractures can become cold during the perioperative period despite measures applied to maintain warmth. Poor temperature control is linked with increasing complications and poorer functional outcomes. There is generic evidence for the benefits of maintaining normothermia, however this is sparse where specifically concerning hip fracture. We provide the first comprehensive review in this population. Significance: Large studies have revealed dramatic impact on wound infection, transfusion rates, increased morbidity and mortality. With very few studies relating to hip fracture patients, this review aimed to capture an overview of available literature regarding hypothermia and its impact on outcomes. Results: Increased mortality, readmission rates and surgical site infections are all associated with poor temperature control. This is more profound, and more common, in older frail patients. Increasing age and lower BMI were recognized as demographic factors ...
The effects of warming fluid on hypothermia, blood transfusion in hip replacement
Annals of Clinical and Analytical Medicine, 2021
Aim: Inadvertent intraoperative hypothermia is a common problem but it can be avoided. Passive isolation and active heating methods are used to prevent inadvertent intraoperative hypothermia. The aim of this study was to investigate the effect of warming intravenous fluids on hypothermia, blood loss, and transfusion in total hip replacement surgery. Material and Methods: After the approval of the ethics committee was obtained, the files of 69 patients who underwent total hip replacement operation between December2014 and July2015 as well as the hospital's data system were analyzed retrospectively. Nine patients with missing data were excluded. We included in the study 60 patients aged 30-90 years, with ASA1-3,weighing 50-100kg, normal coagulation tests normal and spinal anesthesia. The patients were divided into two groups as Group1(n=28), in which the intraoperative intravenous fluids were warmed and Group2(n=32),in which liquids were not warmed. Groups were analyzed with regard to hypothermia, amount of bleeding, transfused blood, amount of fluid injected intraoperatively, and pre-postoperative hemoglobin-hematocrit changes. Results: Hypothermia was observed in both groups. In Group 1, body temperature was significantly higher than Group 2. The amount of fluid given(lt) and the amount of blood loss(ml) were both significantly lower while postoperative hemoglobin-hematocrit values were significantly higher in Group 1(p <0.05). No significant difference was found between the two groups in terms of blood transfusion. Discussion: Hypothermia is a problem in hip replacement surgery. Although we have used the convective air warming system and heated intravenous fluids, we observed intraoperative hypothermia in both groups. Therefore, we suggest that temperature monitoring and patient warming should be a routine procedure in the pre-intra-postoperative phase.
Effect of hypothermia on haemostasis and bleeding risk: a narrative review
Journal of International Medical Research
It must be remembered that clinically important haemostasis occurs in vivo and not in a tube, and that variables such as the number of bleeding events and bleeding volume are more robust measures of bleeding risk than the results of analyses. In this narrative review, we highlight trauma, surgery, and mild induced hypothermia as three clinically important situations in which the effects of hypothermia on haemostasis are important. In observational studies of trauma, hypothermia (body temperature <35°C) has demonstrated an association with mortality and morbidity, perhaps owing to its effect on haemostatic functions. Randomised trials have shown that hypothermia causes increased bleeding during surgery. Although causality between hypothermia and bleeding risk has not been well established, there is a clear association between hypothermia and negative outcomes in connection with trauma, surgery, and accidental hypothermia; thus, it is crucial to rewarm patients in these clinical si...
Resuscitation, 2011
Background: Serious sequelae have been associated with injured patients who are hypothermic (<35 • C) including coagulopathy, acidosis, decreased myocardial contractility and risk of mortality. Aim: Establish the incidence of accidental hypothermia in major trauma patients and identify causative factors. Method: Prospective identification and subsequent review of 732 medical records of major trauma patients presenting to an Adult Major Trauma Centre was undertaken between January and December 2008. Multivariate analysis was performed using logistic regression. Significant and clinically relevant variables from univariate analysis were entered into multivariate models to evaluate determinants for hypothermia and for death. Goodness of fit was determined with the use of the Hosmer-Lemeshow statistic. Main results: Overall mortality was 9.15%. The incidence of hypothermia was 13.25%. The mortality of patients with hypothermia was 29.9% with a threefold independent risk of death: OR (CI 95%) 3.44 (1.48-7.99), P = 0.04. Independent determinants for hypothermia were pre-hospital intubation: OR (CI 95%) 5.18 (2.77-9.71), P < 0.001, Injury Severity Score (ISS): 1.04 (1.01-1.06), P = 0.01, Arrival Systolic Blood Pressure (ASBP) < 100 mm Hg: 3.04 (1.24-7.44), P = 0.02, and wintertime: 1.84 (1.06-3.21), P = 0.03. Of the 87 hypothermic patients who had repeat temperatures recorded in the Emergency Department, 77 (88.51%) patients had a temperature greater than the recorded arrival temperature. There was no change in recorded temperature for four (4.60%) patients, whereas six (6.90%) patients were colder at Emergency Department discharge. Conclusion: Seriously injured patients with accidental hypothermia have a higher mortality independent of measured risk factors. For patients with multiple injuries a coordinated effort by paramedics, nurses and doctors is required to focus efforts toward early resolution of hypothermia aiming to achieve a temperature >35 • C.