title: Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. A multimodal infection control and patient safety intervention to reduce surgical site infections in Africa: a multicentre, before-after, cohort study. Validation of Computerized Sniffer for Monitoring Perioperative Normothermia Multistate point-prevalence survey of health care-associated infections. Effect of prewarming on post-induction core temperature and the incidence of inadvertent perioperative hypothermia in patients undergoing general anaesthesia. Effect of Prewarming during Induction of Anesthesia on Microvascular Reactivity in Patients Undergoing Off-Pump Coronary Artery Bypass Surgery: A Randomized Clinical Trial Normothermia to Prevent Surgical Site Infections After Gastrointestinal Surgery: Holy Grail or False Idol? Preoperative combined with intraoperative skin-surface warming avoids hypothermia caused by general anesthesia and surgery. Perioperative warming, oxygen, and Ilomedin on oxygenation and healing in infrainguinal bypass surgery. A randomized trial of prewarming on patient satisfaction and thermal comfort in outpatient surgery. Does the addition of active body warming to in-line intravenous fluid warming prevent maternal hypothermia during elective caesarean section? A randomised controlled trial. Effects of preoperative warming on the incidence of wound infection after clean surgery: a randomised controlled trial Effect of preoperative warming on intraoperative hypothermia: a randomized-controlled trial Maintaining intraoperative normothermia reduces blood loss in patients undergoing major operations: a pilot randomized controlled clinical trial Negative Pressure Wound Therapy for Surgical-site Infections: A Randomized Trial. The effects of a forced-air warming system plus electric blanket for elderly patients undergoing transurethral resection of the prostate Evaluation of Wound Photography for Remote Postoperative Assessment of Surgical Site Infections Association between Normothermia at the End of Surgery and Postoperative Complications following Orthopaedic Surgery. Aortic arch surgery with hypothermic circulatory arrest and unilateral antegrade cerebral perfusion: Perioperative outcomes. A Prospective Clinical Trial Measuring the Effects of Cardiopulmonary Bypass Under Mild Hypothermia on the Inflammatory Response and Regulation of Cold-Shock Protein RNA-Binding Motif 3. Warming with an underbody warming system reduces intraoperative hypothermia in patients undergoing laparoscopic gastrointestinal surgery: a randomized controlled study. Preoperative Warming Versus no Preoperative Warming for Maintenance of Normothermia in Women Receiving Intrathecal Morphine for Cesarean Delivery: A Single-Blinded, Randomized Controlled Trial
abstract: BACKGROUND Mild perioperative hypothermia , which is common during major surgery , may promote surgical-wound infection by triggering thermoregulatory vasoconstriction , which decreases subcutaneous oxygen tension . Reduced levels of oxygen in tissue impair oxidative killing by neutrophils and decrease the strength of the healing wound by reducing the deposition of collagen . Hypothermia also directly impairs immune function . We tested the hypothesis that hypothermia both increases susceptibility to surgical-wound infection and lengthens hospitalization . METHODS Two hundred patients undergoing colorectal surgery were r and omly assigned to routine intraoperative thermal care ( the hypothermia group ) or additional warming ( the normothermia group ) . The patient 's anesthetic care was st and ardized , and they were all given cefam and ole and metronidazole . In a double-blind protocol , their wounds were evaluated daily until discharge from the hospital and in the clinic after two weeks ; wounds containing culture-positive pus were considered infected . The patients ' surgeons remained unaware of the patients ' group assignments . RESULTS The mean ( + /- SD ) final intraoperative core temperature was 34.7 + /- 0.6 degrees C in the hypothermia group and 36.6 + /- 0.5 degrees C in the normothermia group ( P < 0.001 ) Surgical-wound infections were found in 18 of 96 patients assigned to hypothermia ( 19 percent ) but in only 6 of 104 patients assigned to normothermia ( 6 percent , P = 0.009 ) . The sutures were removed one day later in the patients assigned to hypothermia than in those assigned to normothermia ( P = 0.002 ) , and the duration of hospitalization was prolonged by 2.6 days ( approximately 20 percent ) in hypothermia group ( P = 0.01 ) . CONCLUSIONS Hypothermia itself may delay healing and predispose patients to wound infections . Maintaining normothermia intraoperatively is likely to decrease the incidence of infectious complications in patients undergoing colorectal resection and to shorten their hospitalizations BACKGROUND  Surgical site infections ( SSIs ) are the most frequent health-care-associated infections in developing countries . Specific prevention measures are highly effective , but are often poorly implemented . We aim ed to establish the effect of a multimodal intervention on SSIs in Africa . METHODS We did a before-after cohort study , between July 1 , 2013 , and Dec 31 , 2015 , at five African hospitals . The multimodal intervention consisted of the implementation or strengthening of multiple SSI prevention measures , combined with an adaptive approach aim ed at the improvement of teamwork and the safety climate . The primary outcome was the first occurrence of SSI , and the secondary outcome was death within 30 days post surgery . Data on adherence to SSI prevention measures were prospect ively collected . The intervention effect on SSI risk and death within 30 days post surgery was assessed in a mixed-effects logistic regression model , after adjustment for key confounders . FINDINGS Four hospitals completed the baseline and follow-up ; three provided suitable ( ie , sufficient number and quality ) data for the sustainability period . 4322 operations were followed up ( 1604 at baseline , 1827 at follow-up , and 891 in the sustainability period )  . SSI cumulative incidence significantly decreased post intervention , from 8·0 % ( 95 % CI 6·8 - 9·5 ; n=129 ) to 3·8 % ( 3·0 - 4·8 ; n=70 ; p<0·0001 ) , and this decrease persisted in the sustainability period ( 3·9 % , 2·8 - 5·4 ; n=35 ) . A substantial improvement in compliance with prevention measures was consistently observed in the follow-up and sustainability periods . The likelihood of SSI during follow-up was significantly lower than pre-intervention ( odds ratio [ OR ] 0·40 , 95 % CI 0·29 - 0·54 ; p<0·0001 ) , but the likelihood of death was not significantly reduced ( 0·72 , 0·42 - 1·24 ; p=0·2360 ) . INTERPRETATION Implementation of our intervention is feasible in African hospitals . Improvement was observed across all perioperative prevention practice s. A significant effect on the overall SSI risk was observed , but with some heterogeneity between sites . Further large-scale experimental studies are needed to confirm these results and to improve the sustainability and long-term effect of such complex programmes . FUNDING US Agency for Healthcare Research and Quality , WHO INTRODUCTION The World Health Organization sets a st and ard to maintain patient core temperature greater than 36 ° C throughout the perioperative period . Normothermia ( defined as > 36 ° C ) in the Operating Room ( OR ) is an important factor to preventing complications in patients ( MI , infection , coagulopathy ) . R and omized studies suggests that maintaining at higher temperatures may further reduce complications in surgery ( less complications for group at 36.4 ° C than the control group at 36.0 ° C ) [ 1,2 ] . Perioperative normothermia is an important but often unrecognized element during anesthesia . Early recognition of hypothermia would allow for appropriate interventions and prevent complications . METHODOLOGY Manual validation of the diagnostic performance a clinical tool ( alert ) that would automatically measure changes in core temperature to identify patients who fail to be in range of normothermia during surgery . RESULTS The clinical tool ( alert ) was found to be 97 % sensitive BACKGROUND Currently , no single U.S. surveillance system can provide estimates of the burden of all types of health care-associated infections across acute care patient population s. We conducted a prevalence survey in 10 geographically diverse states to determine the prevalence of health care-associated infections in acute care hospitals and generate up date d estimates of the national burden of such infections . METHODS We defined health care-associated infections with the use of National Healthcare Safety Network criteria .  One-day surveys of r and omly selected in patients were performed in participating hospitals . Hospital personnel collected demographic and limited clinical data . Trained data collectors review ed medical records retrospectively to identify health care-associated infections active at the time of the survey . Survey data and 2010 Nationwide Inpatient Sample data , stratified according to patient age and length of hospital stay , were used to estimate the total numbers of health care-associated infections and of in patients with such infections in U.S. acute care hospitals in 2011 . RESULTS Surveys were conducted in 183 hospitals . Of 11,282 patients , 452 had 1 or more health care-associated infections  ( 4.0 % ; 95 % confidence interval , 3.7 to 4.4 ) . Of 504 such infections , the most common types were pneumonia ( 21.8 % ) , surgical-site infections ( 21.8 % ) , and gastrointestinal infections ( 17.1 % ) . Clostridium difficile was the most commonly reported pathogen ( causing 12.1 % of health care-associated infections ) . Device-associated infections ( i.e. , central -catheter-associated bloodstream infection , catheter-associated urinary tract infection , and ventilator-associated pneumonia ) , which have traditionally been the focus of programs to prevent health care-associated infections , accounted for 25.6 % of such infections . We estimated that there were 648,000 patients with 721,800 health care-associated infections in U.S. acute care hospitals in 2011 . CONCLUSIONS Results of this multistate prevalence survey of health care-associated infections indicate that public health surveillance and prevention activities should continue to address C. difficile infections . As device- and procedure-associated infections decrease , consideration should be given to exp and ing surveillance and prevention activities to include other health care-associated infections BACKGROUND Inadvertent perioperative hypothermia ( IPH ) occurs in many patients because warming techniques are insufficient to counteract thermal redistribution result ing from the ablation of thermoregulatory vasoconstriction associated with anaesthesia . We tested the efficiency of a preoperative forced-air warming ( FAW ) device ( Bair Paws ) in preventing IPH . METHODS Sixty-eight adult patients undergoing spinal surgery under general anaesthesia were r and omized to receive either normal care or prewarming for 60 min , at 38 degrees C , using the Bair Paws system . All patients received routine FAW intraoperatively . RESULTS Thirty-one patients were prewarmed and 37 patients were in the control group . There was a 0.3 degrees C smaller decrease in mean core temperature in the prewarmed group at 40 , 60 , and 80 min post-induction ( P < or = 0.05 ) . Temperature was maintained above the hypothermic threshold of 36 degrees C in 21 ( 68 % ) patients in the prewarmed group , compared with 16 ( 43 % ) patients in the control group ( P<0.05 ) . CONCLUSIONS Preoperative warming using the Bair Paws system results in smaller decreases in core temperature intraoperatively and less IPH in patients undergoing spinal surgery under general anaesthesia Background General anesthesia may induce inadvertent hypothermia and this may be related to perioperative cardiovascular complications . Microvascular reactivity , measured by the recovery slope during a vascular occlusion test , is decreased during surgery and is also related to postoperative clinical outcomes . We hypothesized that microvascular changes during surgery may be related to intraoperative hypothermia . To evaluate this , we conducted a r and omized study in patients undergoing off-pump coronary artery bypass surgery , in which the effect of prewarming on microvascular reactivity was evaluated . Methods Patients scheduled for off-pump coronary artery bypass surgery were screened . Enrolled patients were r and omized to the prewarming group to receive forced-air warming during induction of anesthesia or to the control group . Measurement of core and skin temperatures and vascular occlusion test were conducted before anesthesia induction , 1 , 2 , and 3 h after induction , and at the end of surgery . Results In total , 40 patients were enrolled and finished the study ( n = 20 in the prewarming group and n = 20 in the control group ) . During the first 3 h of anesthesia , core temperature was higher in the prewarming group than the control group ( p < 0.001 ) . The number of patients developing hypothermia was lower in the prewarming group than the control group ( 4/20 vs. 13/20 , p = 0.004 ) . However , tissue oxygen saturation and changes in recovery slope following a vascular occlusion test at 3 h after anesthesia induction did not differ between the groups . There was no difference in clinical outcome , including perioperative transfusion , wound infection , or hospital stay , between the groups . Conclusions Prewarming during induction of anesthesia decreased intraoperative hypothermia , but did not reduce the deterioration in microvascular reactivity in patients undergoing off-pump coronary artery bypass surgery . Trial Registration Clinical Trials.gov Objective : To analyze the association between perioperative normothermia ( temperature ≥36 ° C ) and  surgical site infections ( SSIs ) after gastrointestinal ( GI ) surgery . Summary of Background Data : Although active warming during colorectal surgery reduces SSIs , there is limited evidence that perioperative normothermia is associated with lower rates of SSI . Nonetheless , hospitals participating in the Surgical Care Improvement Project must report normothermia rates during major surgery . Methods : We conducted a nested , matched , case-control study ; cases consisted of GI surgery patients enrolled in our National Surgical Quality Improvement Program data base between March 2006 and March 2009 who developed SSIs . Patient/surgery risk factors for SSI were obtained from the National Surgical Quality Improvement Program data base . Perioperative temperature/antibiotic/glucose data were obtained from medical records . Cases/controls were compared using univariate/r and om effects/logistic regression models . Independent risk factors for SSIs were identified using multivariate/r and om effects/logistic regression models . Results : A total of 146 cases and 323 matched controls were identified ; 82 % of patients underwent noncolorectal surgery . Cases were more likely to have final intraoperative normothermia compared with controls ( 87.6 % vs. 77.8 % , P = 0.015 ) ; rates of immediate postoperative normothermia were similar ( 70.6 % vs. 65.3 % , respectively , P = 0.19 ) . Emergent surgery/higher wound class were associated with higher rates of intraoperative normothermia . Independent risk factors for SSI were diabetes , surgical complexity , small bowel surgery , and nonlaparoscopic surgery . There was no independent association between perioperative normothermia and SSI ( adjusted odds ratio , 1.05 ; 95 % confidence interval , 0.48–2.33 ; P = 0.90 ) . Conclusions : Pay-for-reporting measures focusing on perioperative normothermia may be of limited value in preventing SSI after GI surgery . Studies to define the benefit of active warming after noncolorectal GI surgery are warranted STUDY OBJECTIVES To evaluate the effects of intraoperative skin-surface warming with and without 1 hour of preoperative warming , in preventing intraoperative hypothermia , and postoperative hypothermia , and shivering , and in offering good conditions to early tracheal extubation . DESIGN Prospect i ve , r and omized , blind study . SETTING Teaching hospital . PATIENTS 30 ASA physical status I and II female patients scheduled for elective abdominal surgery . INTERVENTIONS Patients received st and ard general anesthesia . In 10 patients , no special pre caution s were taken to avoid hypothermia . Ten patients were su bmi tted to preoperative and intraoperative active warming . Ten patients were only warmed intraoperatively . MEASUREMENTS AND MAIN RESULTS Temperatures were recorded at 15-minute intervals . The patients who were warmed preoperatively and intraoperatively had core temperatures significantly more elevated than the other patients during the first two hours of anesthesia . All patients warmed intraoperatively were normothermic only at the end of the surgery . The majority of the patients warmed preoperatively and intraoperatively or intraoperatively only were extubated early , and none had shivering . In contrast , five unwarmed patients shivered . CONCLUSIONS One hour of preoperative warning combined with intraoperative skin-surface warming , not simply intraoperative warming alone , avoided hypothermia caused by general anesthesia during the first two hours of surgery . Both methods prevented postoperative hypothermia and shivering and offered good conditions for early tracheal extubation BACKGROUND Perioperative adjuncts are utilized across surgical specialities with the goal of improving patient outcomes . High-dose oxygen and extended warming are shown to increase wound collagen deposition during abdominal surgery . Prostacyclin is shown to improve limb salvage and patency rate in infrainguinal bypass ( IIB ) surgery . This study evaluated the impact of these adjuncts on healing and perfusion post IIB surgery . METHODS This r and omized controlled study allocated patients undergoing IIB surgery into three treatment arms ( perioperative high-dose oxygen , extended warming , and a synthetic prostacyclin ) or a control group . The primary outcome was accumulation of hydroxyproline ( OHP , collagen surrogate marker ) as collected in polytetrafluoroethylene implants on day 5 . Secondary outcomes included levels of growth factors and cytokines , and tissue oxygenation of the wound and foot as measured by hyperspectral technology and ankle-brachial pressure index . Clinical outcomes were observed to day 30 , with long-term follow-up of 12 mo . RESULTS Seventy-one patients completed the study . Comparing treatment groups with the control at day 5 , there were no differences in OHP , growth factors or cytokines levels , or improvement in tissue oxygenation at the surgical incision . However , there was more flow to the foot ( HT-SUM ( % ) change ) in the Ilomedin group compared to control ( 0 % versus -14.6 % , P = 0.045 ) . HT-deoxy was higher at the peripheries in the oxygen and temperature groups , suggesting decreased tissue oxygenation . CONCLUSIONS The perioperative treatments did not dramatically improve oxygenation or healing of the surgical wound in IIB surgery ; however , Ilomedin may result in greater flow to the peripheries STUDY OBJECTIVE To test the primary hypothesis that forced-air prewarming improves patient satisfaction after outpatient surgery and to evaluate the effect on core temperature and thermal comfort . DESIGN Prospect i ve r and omized controlled trial . SETTING Preoperative area , operating room , and postanesthesia care unit . PATIENTS A total of 115 patients aged 18 to 75 years with American Society of Anesthesiologists status < 4 and body mass index of 15 to 36kg/m(2 ) who were undergoing outpatient surgery ( duration < 4 hours ) . INTERVENTIONS Patients were r and omized to active prewarming with a Mistral-Air warming system initially set to 43 ° C or no active prewarming . All patients were warmed intraoperatively . MEASUREMENTS Demographic and morphometric characteristics , perioperative core temperature , ambient temperature , EVAN-G satisfaction score , thermal comfort via visual analog scales . MAIN RESULTS Data from 102 patients were included in the final analysis . Prewarming did not significantly reduce redistribution hypothermia , with prewarmed minus not prewarmed core temperature differing by only 0.18 ° C ( 95 % confidence interval [ CI ] , -0.001 to 0.37 ) during the initial hour of anesthesia ( P=.052 ) . Prewarming increased the mean EVAN-G satisfaction score , although not significantly , with an overall difference ( prewarmed minus not prewarmed ) of 5.6 ( 95 % CI , -0.9 to 12.2 ; P=.09 ) . Prewarming increased thermal comfort , with an overall difference of 6.6 mm ( 95 % CI , 1.0 - 12.9 ; P=.02 ) . CONCLUSION Active prewarming increased thermal comfort but did not significantly reduce redistribution hypothermia or improve postoperative patient satisfaction INTRODUCTION Inadvertent perioperative hypothermia occurs frequently during elective caesarean section but perioperative active body warming is not widely used . There is a paucity of evidence of its use in the obstetric population , and no applicable guidelines . We set out to identify a superior active warming method for preventing inadvertent perioperative hypothermia . METHODS Following ethical approval , 132 women presenting for uncomplicated elective caesarean section under spinal anaesthesia were recruited . All participants received in-line intravenous fluid warming and were r and omised to one of three parallel groups : no active body warming ; forced air warming ; and conduction mattress warming . The primary outcome was the difference in mean core temperature , measured on admission to the recovery room , between study groups . Core temperature and thermal comfort were measured perioperatively at 15-min intervals . Estimated blood loss , haemoglobin change , length of hospital stay and neonatal core temperature were also recorded . RESULTS One-hundred- and -thirty-one women completed the study . There was no significant difference in mean core temperature on admission to the recovery room ( 36.6 ° C vs. 36.6 ° C vs. 36.6 ° C , η2=0.005 , P=0.74 ) . Maternal hypothermia was prevented in all groups with only 0.3 % hypothermic at any of the temperature measurements ( 3/1016 ) . There was no difference in mean neonatal core temperature ( 36.3 ° C vs. 36.3 ° C vs. 36.3 ° C , η2=0.003 , P=0.82 ) ; however , 59.4 % ( 76/128 ) of all neonates were hypothermic . CONCLUSION In-line intravenous fluid warming is sufficient to prevent maternal hypothermia and maintain core temperature . The addition of active body warming conferred no added benefit BACKGROUND Wound infection after clean surgery is an expensive and often underestimated cause of patient morbidity , and the benefits of using prophylactic antibiotics have not been proven . Warming patients during colorectal surgery has been shown to reduce infection rates . We aim ed to assess whether warming patients before short duration , clean surgery would have the same effect . METHODS 421 patients having clean ( breast , varicose vein , or hernia ) surgery were r and omly assigned to either a non-warmed ( st and ard ) group or one of two warmed groups ( local and systemic ) . We applied warming for at least 30 min before surgery . Patients were followed up and masked outcome assessment s made at 2 and 6 weeks . FINDINGS Analysis was done on an intention-to-treat basis . We identified 19 wound infections in 139 non-warmed patients ( 14 % ) but only 13 in 277 who received warming ( 5 % ; p=0.001 ) . Wound scores were also significantly lower ( p=0.007 ) in warmed patients . There was no significant difference in the development of haematomas or seromas after surgery but the non-warmed group were prescribed significantly more postoperative antibiotics ( p=0.002 ) . INTERPRETATION Warming patients before clean surgery seems to aid the prevention of postoperative wound infection . If applied according to the manufacturers guidelines these therapies have no known side-effects and might , with the support of further studies , provide an alternative to prophylactic antibiotics in this type of surgery Purpose The purpose of this study was to evaluate the effects of preoperative forced-air warming on intraoperative hypothermia . Methods In this r and omized-controlled trial , adult patients scheduled for elective , non-cardiac surgery under general anesthesia were stratified by scheduled surgical duration ( < 2.5 hr or ≥ 2.5 hr ) and then r and omized to a pre-warming group using a BairPaws ™ forced-air warming system for at least 30 min preoperatively or to a control group with warmed blankets on request . All patients were warmed intraoperatively via convective forced-air warming blankets .  Perioperative temperature was measured using the SpotOn ™ temperature system consisting of a single-use disposable sensor applied to the participant ’s forehead . The primary outcome was the magnitude of intraoperative hypothermia calculated as the area under the time-temperature curve for core temperatures < 36 ° C between induction of general anesthesia and leaving the operating room . Secondary outcomes included surgical site infections , packed red blood cell requirements , and 24 hr postoperative opioid consumption . Results Two hundred participants were analyzed ( 101 control ; 99 pre-warmed ) . Pre-warmed participants had a lower median [ interquartile range ] magnitude of hypothermia than controls ( 0.00 [ 0.00 - 0.12 ] ° C·hr−1vs 0.05 [ 0.00 - 0.36 ] ° C·hr−1 , respectively ; median difference , −0.01 ° C·hr−1 ; 95 % confidence interval , −0.04 to 0.00 ° C·hr−1 ; P = 0.005 ) . There were no between-group differences in the secondary outcomes . Conclusion A minimum of 30 min of preoperative forced-air convective warming decreased the overall intraoperative hypothermic exposure . While redistribution hypothermia still occurs despite pre- and intraoperative forced-air warming , their combined application results in greater preservation of intraoperative normothermia compared with intraoperative forced-air warming alone . Trial registration www . clinical trials.gov ( NCT02177903 ) . Registered 25 June 2014.RésuméObjectifL’objectif de cette étude était d’évaluer les conséquences du réchauffement préopératoire par air forcé sur l’hypothermie peropératoire . MéthodesDans cette étude r and omisée contrôlée , des patients adultes devant subir une chirurgie élective non cardiaque sous anesthésie générale ont été stratifiés en fonction de la durée prévue de l’intervention ( < 2,5 h ou ≥ 2,5 h ) puis r and omisés dans un groupe de réchauffement préalable utilisant un système à air forcé BairPaws ™ pendant au moins 30 min en préopératoire ou dans un groupe témoin avec couvertures chauffantes sur dem and e. Tous les patients ont été réchauffés pendant l’intervention au moyen de couvertures chauffantes à air forcé par convection . La température périopératoire a été mesurée au moyen du système de surveillance de la température SpotOnMD consistant en un capteur jetable à usage unique placé sur le front des patients . Le critère principal d’évaluation était l’ampleur de l’hypothermie peropératoire calculée comme l’aire sous la courbe température-temps pour des températures central es < 36 ° C entre l’induction de l’anesthésie générale et la sortie de la salle d’opération . Les critères d’évaluation secondaires ont inclus les infections du site chirurgical , le nombre de culots de globules rouges nécessaires et la consommation d’opioïdes au cours des 24 heures postopératoires . RésultatsLes résultats de 200 participants ont été analysés ( 101 contrôles ; 99 patients préréchauffés ) . L’amplitude médiane de l’hypothermie [ écart interquartile ] des participants préréchauffés a été plus faible que celle des contrôles ( respectivement , 0,00 [ 0,00 - 0,12 ] ° C·hr−1 contre 0,05 [ 0,00 - 0,36 ] ° C·hr−1 ; différence entre médianes , −0,01 ° C·hr−1 ; intervalle de confiance à 95 % , −0,04 à 0,00 ° C·hr−1 ; P < 0,005 ) . Il n’y a pas eu de différence entre les groupes sur les critères d’évaluation secondaires . Conclusion Un minimum de 30 min de réchauffement préopératoire au moyen d’un système à air forcé à convection a diminué l’exposition globale à l’hypothermie peropératoire . Bien qu’une hypothermie de redistribution survienne toujours en dépit du réchauffement peropératoire à l’air forcé , leur application combinée entraîne une meilleure conservation de la normothermie peropératoire , comparativement au réchauffement peropératoire à l’air forcé seul . Enregistrement de l’essai cliniquewww.essaiscliniques.gov ( NCT02177903 ) . Enregistré le 25 juin 2014 Background Inadvertent intraoperative hypothermia ( core temperature < 36 ° C ) is a common but preventable adverse event . This study aim ed to determine whether active intraoperative warming reduced bleeding in patients undergoing major operations : open thoracic surgery and hip replacement surgery . Methods / Design The study was a pilot , prospect i ve , parallel two-arm r and omized controlled trial . Eligible patients were r and omly allocated to two groups : passive warming ( PW ) , with application of a cotton blanket ( thermal insulation ) , or active warming ( AW ) , with a forced-air warming system . The primary endpoint was intraoperative blood loss , and secondary endpoints were surgical-site infection , cardiovascular events , and length of stay in the post-anesthesia care unit , intensive care unit , and hospital . Results Sixty-two patients were enrolled . Forced-air active warming maintained intraoperative normothermia in all AW subjects , whereas intraoperative hypothermia occurred in 21/32 ( 71.8 % ) of PW patients ( p = 0.000 ) . The volume of blood loss was more in the PW group ( 682 ± 426 ml ) than in the AW group ( 464 ± 324 ml ) ( p < 0.021 ) , and the perioperative hemoglobin value declined more in the PW group ( 28.6 ± 17.5 g/L ) than in the AW group ( 21.0 ± 9.9 g/L ) ( p = 0.045 ) . However , there were no difference in other clinical outcomes between two groups . Conclusion Intraoperative active warming is associated with less blood loss than passive warming in open thoracic and hip replacement operations in this pilot study .Trial registration This trial was registered with Clinical trials.gov ( Identifier : NCT02214524 ) on 27 August 2014 OBJECTIVE This study seeks to evaluate the efficacy of negative pressure wound therapy for surgical-site infection ( SSI ) after open pancreaticoduodenectomy . BACKGROUND Despite improvement in infection control , SSIs remain a common cause of morbidity after abdominal surgery . SSI has been associated with an increased risk of reoperation , prolonged hospitalization , readmission , and higher costs . Recent retrospective studies have suggested that the use of negative pressure wound therapy can potentially prevent this complication . METHODS We conducted a single-center r and omized , controlled trial evaluating surgical incision closure during pancreaticoduodenectomy using  negative pressure wound therapy in patients at high risk for SSI . We r and omly assigned patients to receive negative pressure wound therapy or a st and ard wound closure . The primary end point of the study was the occurrence of a postoperative SSI . We evaluated the economic impact of the intervention . RESULTS From January 2017 through February 2018 , we r and omized 123 patients at the time of closure of the surgical incision .  SSI occurred in 9.7 % ( 6/62 ) of patients in the negative pressure wound therapy group and in 31.1 % ( 19/61 ) of patients in the st and ard closure group ( relative risk = 0.31 ; 95 % confidence interval , 0.13 - 0.73 ; P = 0.003 ) . This corresponded to a relative risk reduction of 68.8 % . SSIs were found to independently increase the cost of hospitalization by 23.8 % . CONCLUSIONS The use of negative pressure wound therapy result ed in a significantly lower risk of SSIs . Incorporating this intervention in surgical practice can help reduce a complication that significantly increases patient harm and healthcare costs Background : Perioperative inadvertent hypothermia in elderly urology patients undergoing transurethral resection of the prostate ( TURP ) is a well-known serious complication , as it increases the risk of myocardial ischemia , blood loss , and surgical wound infection . We conducted this prospect i ve r and omized controlled trial to evaluate the combined effect of a forced-air warming system and electric blanket in elderly TURP patients . Methods : Between January 2015 and October 2017 , we recruited 443 elderly male patients undergoing elective TURP with subarachnoid blockade ( SAB ) . These were r and omly divided into 3 groups : group E ( intraoperative warming using electric blankets set to 38 ° C ; n = 128 ) ; group F ( intraoperative warming using a forced-air warmer set to 38 ° C ; n = 155 ) and group FE ( intraoperative warming using a forced-air warmer plus electric blankets , both set to 38 ° C ; n = 160 ) . The primary outcome was shivering and their grade s. Hemodynamic changes , esophageal temperature , recovery time , incidences of adverse effects , and patient and surgeon satisfaction were also recorded . Results : Baseline characteristics showed no significant differences when compared across the 3 groups ( P > .05 ) . Compared with groups E and F , both HR and mean arterial pressure ( MAP ) in group FE were significantly decreased from T6 to T10 ( P < .05 ) . Compared with groups E and F , esophageal temperature in group FE increased significantly from T5 to T10 ( P < .05 ) . Compared with group E , esophageal temperature in group F was significantly increased from T5 to T10 ( P < .05 ) . Compared with groups F and FE , post-anesthesia care unit ( PACU ) recovery time was longer in group E , while compared with group F , PACU recovery time was shorter in group FE ( P < .05 ) . Compared to patients in groups E and F , those in group FE had a significantly lower incidence of arrhythmia and shivering ( P < .05 ) . The number of patients with shivering grade s 0 to 3 was higher in group E than in other groups , while the number of patients with shivering grade 2 was significantly higher in group F than in group FE ( P < .05 ) . Patient and surgeon satisfaction scores were higher in group FE than in groups E and F ( P < .05 ) . Conclusions : Use of a forced-air warming system combined with an electric blanket was an effective method with which to retain warmth among elderly TURP patients Importance Surgeons are increasingly interested in using mobile and online applications with wound photography to monitor patients after surgery . Early work using remote care to diagnose surgical site infections ( SSIs ) demonstrated improved diagnostic accuracy using wound photographs to augment patients ’ electronic reports of symptoms , but it is unclear whether these findings are reproducible in real-world practice . Objective To determine how wound photography affects surgeons ’ abilities to diagnose SSIs in a pragmatic setting . Design , Setting , and Participants This prospect i ve study compared surgeons ’ paired assessment s of postabdominal surgery case vignettes with vs without wound photography for detection of SSIs . Data for case vignettes were collected prospect ively from May 1 , 2007 , to January 31 , 2009 , at Erasmus University Medical Center , Rotterdam , the Netherl and s , and from July 1 , 2015 , to February 29 , 2016 , at V and erbilt University Medical Center , Nashville , Tennessee . The surgeons were members of the American Medical Association whose self- design ated specialty is general , abdominal , colorectal , oncologic , or vascular surgery and who completed internet-based assessment s from May 21 to June 10 , 2016 . Intervention Surgeons review ed online clinical vignettes with or without wound photography . Main Outcomes and Measures Surgeons ’ diagnostic accuracy , sensitivity , specificity , confidence , and proposed management with respect to SSIs . Results A total of 523 surgeons ( 113 women and 410 men ; mean [ SD ] age , 53 [ 10 ] years ) completed a mean of 2.9 clinical vignettes . For the diagnosis of SSIs , the addition of wound photography did not change accuracy ( 863 of 1512 [ 57.1 % ] without and 878 of 1512 [ 58.1 % ] with photographs ) . Photographs decreased sensitivity ( from 0.58 to 0.50 ) but increased specificity ( from 0.56 to 0.63 ) . In 415 of 1512 cases ( 27.4 % ) , the addition of wound photography changed the surgeons ’ assessment ( 215 of 1512 [ 14.2 % ] changed from incorrect to correct and 200 of 1512 [ 13.2 % ] changed from correct to incorrect ) . Surgeons reported greater confidence when vignettes included a wound photograph compared with vignettes without a wound photograph , regardless of whether they correctly identified an SSI ( median , 8 [ interquartile range , 6 - 9 ] vs median , 8 [ interquartile range , 7 - 9 ] ; P < .001 ) but they were more likely to undertriage patients when vignettes included a wound photograph , regardless of whether they correctly identified an SSI . Conclusions and Relevance In a practical simulation , wound photography increased specificity and surgeon confidence , but worsened sensitivity for detection of SSIs . Remote evaluation of patient-generated wound photographs may not accurately reflect the clinical state of surgical incisions . Effective widespread implementation of remote postoperative assessment with photography may require additional development of tools , participant training , and mechanisms to verify image quality BACKGROUND Maintaining perioperative normothermia is recommended by recent guidelines for prevention of surgical site infection ( SSI ) . However , the majority of supporting data originates outside the field of orthopaedic surgery . METHODS The effect of normothermia was explored using prospect ively collected data of consecutive patients who underwent single-site surgery in seven tertiary referral hospitals between November 2013 and July 2016 . SSI , urinary ( UTI ) and respiratory ( RTI ) tract infections , cardiac and cerebral events ( CCE ) , and all-cause mortality within 30 days after surgery were compared between patients with normothermia ( body temperature > 36 ° C ) and those with hypothermia ( < 36 ° C ) at the end of surgery , after closure . Multivariable adjusted and inverse-probability weighted regression analyses were performed . RESULTS The final cohort included 8,841 patients . Of these , 11.4 % ( n=1,008 ) were hypothermic . More than 96 % were evaluated in-person by the physicians . After adjusting for multiple covariates , normothermia was not significantly associated with SSI ( adjusted odds ratio [ aOR ] 1.18 [ 95 % CI 0.59 - 2.33 ] ) , UTI ( aOR 1.14 [ 95 % CI 0.66 - 1.95 ] ) , RTI ( aOR 0.60 [ 95 % CI 0.31 - 1.19 ] ) , or CCE ( aOR 0.53 [ 95 % CI 0.26 - 1.09 ] ) . In contrast , normothermia was associated with a lower risk of 30-day mortality ( aOR 0.26 [ 95 % CI 0.11 - 0.64 ] ; P<.01 , weighted hazard ratio 0.21 [ 95 % CI 0.07 - 0.68 ] ; P=.002 ) . In subgroup analysis , normothermia was associated with reduced mortality in all types of surgical procedures . CONCLUSIONS Whereas our findings suggest no clear association with SSI risk following orthopaedic surgery , our study supports maintaining perioperative normothermia , as it is associated with reduced 30-day mortality OBJECTIVE The study objective was to determine the effects of surgical procedures , circulatory management strategies , and cerebral protection strategies on the short-term outcomes of  aortic arch surgery  based on the 7-year clinical experience of a single center . METHODS We analyzed the data of 1708 patients who underwent aortic arch surgery with definite hypothermic circulatory arrest and unilateral ante grade cerebral perfusion at Beijing Anzhen Hospital between 2009 and 2015 .  Logistic regression and r and om Forest regression analyses were used to determine predictors and their effects on outcomes . RESULTS Thirty-day mortality was 6.1 % . Permanent neurologic dysfunction incidence was 4.8 % . The proportion of patients requiring continuous renal replacement therapy was 7.9 % . In multivariable analyses , age , DeBakey type I dissection , New York Heart Association score , coma , coronary artery bypass grafting , extra-anatomic bypass , and cardiopulmonary bypass time were independent risk factors for mortality . Age , DeBakey type I dissection , and cardiopulmonary bypass time were independent risk factors for permanent neurologic dysfunction . In the r and om Forest regression , the risk for permanent neurologic dysfunction and mortality increased when unilateral ante grade cerebral perfusion time was more than 38 minutes and decreased with an increase in nasopharyngeal temperature when temperature was lower than approximately 24 ° C . The risk for permanent neurologic dysfunction , continuous renal replacement therapy , and paraplegia increased when temperature was greater than approximately 24 ° C . CONCLUSIONS The study showed that the largest reported cohort of patients undergoing aortic arch surgery with hypothermic circulatory arrest and unilateral ante grade cerebral perfusion had reasonable morbidity and mortality rates . As a cerebral protection strategy , unilateral ante grade cerebral perfusion may have a 38-minute safety threshold . Moderate hypothermia should be maintained below 24 ° C to reduce the risk for permanent neurologic dysfunction , paraplegia , and acute renal dysfunction requiring continuous renal replacement therapy Therapeutic hypothermia during cardiac surgery has been widely used for neuroprotection and to attenuate the systemic inflammatory response due to cardiopulmonary bypass ( CPB ) . Experimental data suggest that cold-shock protein RNA-binding motif 3 ( RBM3 ) , which is induced in response to hypothermia , plays a key role in hypothermia-induced organ protection . To date , investigation on RBM3 has been performed exclusively in vitro or in animal models , and the detection and regulation of RBM3 in human blood has not been investigated until now . The objective was to investigate the level of RBM3 protein and cytokine expression profile involved in the inflammatory response in patients with congenital heart disease undergoing cardiac surgery involving CPB and therapeutic hypothermia .  A single-center prospect i ve trial with 23 patients undergoing cardiac surgery with CPB  was performed . RBM3 protein was quantified in blood serum sample s collected from patients and healthy individuals by employing a new developed enzyme-linked immunosorbent assay .  Cytokine levels were analyzed from dry blood spot sample s by using a Quanterix Simoa Immunoassay . For the first time , RBM3 protein was detected in blood sample s of patients with congenital heart disease undergoing cardiac surgery . Hereby , RBM3 protein concentrations were significantly elevated in patients after cardiac surgery with  CPB  and mild hypothermia as compared with pre-surgery levels . Moreover , a complex immune reaction with significant induction of pro-inflammatory cytokines ( interleukin [IL]-1 beta , IL-6 , IL-8 , IL-16 , IL-18 , monocyte chemotactic protein 1 , CC-chemokine lig and [CCL]3 , CCL4 , intercellular adhesion molecule-1 ) in response to CPB was detected . Significantly elevated vascular endothelial growth factor and matrix metallopeptidase 3 concentrations reflecting ischemia/reperfusion-induced injury were observed 24 hours after weaning from CPB . The use of CPB is still associated with a complex inflammatory response . RBM3 protein is measurable in blood sample s of patients with significantly higher concentrations after cardiac surgery with CPB and mild-to-moderate hypothermia . RBM3 is a new c and i date as a biomarker for therapeutic hypothermia and a possible new therapeutic target for organ protection BACKGROUND Intraoperative hypothermia is a common event during laparoscopic abdominal surgery . On one h and , intraoperative hypothermia can delay the metabolism and prevent tissue damage . One the other h and , long-term and severe intraoperative hypothermia may also lead to perioperative complications , such as increasing of peripheral resistance , coagulation dysfunction , intraoperative hemorrhage and postoperative shivering . Maintenance of normothermia during surgical procedures may improve the quality of patient care . OBJECTIVES This study investigated the feasibility and efficacy of intraoperative cutaneous warming with an underbody warming system during laparoscopic gastrointestinal surgery . METHODS 110 patients undergoing laparoscopic surgery for gastrointestinal cancer between January and December 2011 were r and omized into the laparoscopic control ( Control ) group and laparoscopic intervention ( Intervention ) group . Nasopharyngeal temperature , prothrombin time , activated partial thromboplastin time , and thrombin time were measured before and during surgery , intraoperative and postoperative complications , as well as shivering after anesthesia and visual analog scale score for pain evaluation after surgery were also recorded . Clinical risk factors that may cause intraoperative hypothermia during laparoscopic surgery were also analyzed by correlation analysis . RESULTS The two groups were comparable at the baseline . Intraoperative hypothermia was observed in 29 patients ( 52.7 % ) in Control group and 3 ( 5.5 % ) in Intervention group . Nasopharyngeal temperature in Control group was significantly decreased since 30min after the start of operation until the end of surgery comparing to that at the start of anesthesia , but there was no difference in the Intervention group . In Intervention group , the nasopharyngeal temperature was remaining at ∼36.5 ° C , indicating the feasibility and efficiency of the underbody warming system in preventing intraoperative hypothermia during laparoscopic gastrointestinal surgery . Moreover , with anesthesia and operation time increased , there was no significant change of coagulation function , hemoglobin level as well as less intraoperative hemorrhage , less postoperative shivering and lower visual analog scale score in Intervention group comparing to Control group . Multivariate logistic regression analysis revealed that anesthesia time and volume of CO2 were independent risk factors for perioperative hypothermia . CONCLUSIONS Cutaneous warming with an underbody warming system is a feasible and effective method to prevent intraoperative hypothermia during laparoscopic gastrointestinal surgery BACKGROUND : Rates of hypothermia for women undergoing spinal anesthesia for cesarean delivery are high and prevention is desirable . This trial compared the effectiveness of preoperative warming versus usual care among women receiving intrathecal morphine , which is thought to exacerbate perioperative heat loss . METHODS : A prospect i ve , single-blinded , r and omized controlled trial compared 20 minutes of forced air warming ( plus intravenous fluid warming ) versus no active preoperative warming ( plus intravenous fluid warming ) in 50 healthy American Society of Anesthesiologists grade d II women receiving intrathecal morphine as part of spinal anesthesia for elective cesarean delivery . The primary outcome of maternal temperature change was assessed via aural canal and bladder temperature measurements at regular intervals . Secondary outcomes included maternal thermal comfort , shivering , mean arterial pressure , agreement between aural temperature , and neonatal outcomes ( axillary temperature at birth , Apgar scores , breastfeeding , and skin-to-skin contact ) . The intention-to-treat population was analyzed with descriptive statistics , general linear model analysis , linear mixed-model analysis , & khgr;2 test of independence , Mann-Whitney , and Bl and -Altman analysis . Full ethical approval was obtained , and the study was registered on the Australia and New Zeal and Clinical Trials Registry ( Trial No : 367160 , registered at http://www.ANZCTR.org.au/ ) . RESULTS : Intention-to-treat analysis ( n = 50 ) revealed no significant difference in aural temperature change from baseline to the end of the procedure between groups : F ( 1 , 47 ) = 1.2 , P = .28 . There were no other statistically significant differences between groups in any of the secondary outcomes . CONCLUSIONS : A short period of preoperative warming is not effective in preventing intraoperative temperature decline for women receiving intrathecal morphine . A combination of preoperative and intraoperative warming modalities may be required for this population
target: The results of this study suggest that preoperative warming can reduce rates of SSI after surgery .
background: OBJECTIVE To determine whether preoperative warming can reduce the risk of surgical site infection ( SSI ) after surgery .
  BACKGROUND Intraoperative hypothermia is a risk factor for the occurrence of  SSI in patients after surgery .
  However , the effectiveness of preoperative warming in reducing the incidence of the condition remains unclear .