Postoperative hypothermia in elderly patients
DOI:
https://doi.org/10.25751/rspa.20170Keywords:
hypothermia, elderly, postoperativeAbstract
Background: Early postoperative hypothermia is a preventable complication with adverse consequences on morbidity and patient well-being. This study aimed to determine the incidence of postoperative hypothermia and its related clinical outcome in elderly patients. Materials and Methods: This observational prospective study was approved by the Institutional ethics committee and included patients aged>60 years, submitted to elective surgery and admitted to Post Anaesthetic Care Unit (PACU). Clinical Frailty Scale and The World Health Organization Disability Assessment Schedule were used to evaluate vulnerability and disability. The Richmond Agitation Sedation Scale (RASS) was used at PACU admission (T0) and 15 minutes later. Quality of Recovery-15 was evaluated 24 hours after surgery. At PACU admission, patients with auricular temperature <35ºC were considered to be hypothermic patients (HPP). The Mann-Whitney test, Chi-square or Fisher’s exact test were used for comparison.Results: Of a total of 235 patients, 26% were HPP at PACU admission. HPP had lower scores of RASS at T0 (p=0.044) but at T15 these scores were similar. Hypothermia incidence was not related to type of anesthesia but HPP had a median longer time of anesthesia (p=0.030). These patients were less frequently frail (p= 0.048) and, according to POSSUM, HPP had higher risk of morbidity (p=0.016) and higher risk of mortality (p=0.023). These patients developed more frequently cardiac events (5% vs. 0%, p=0.003).Conclusions: The incidence of hypothermia was considerably high and patients with hypothermia were at higher risk of mortality and morbidity. They had more frequently cardiac events, but their quality of recovery was similar.
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2. Bindu B, Bindra A, Rath G. Temperature management under general anestesia: compulsion or option. Journal of Anaesthesiology Clinical Pharmacology, Volume 33, issue 3, July-September 2017.
3. Sessler D. Temperature monitoring: consequences and prevention of mild perioperative hypothermia. Anesthesiology. 2011; 109: p.1-7.
4. Hart S, Bordes B, Harts J, Corsino D, D. H. Unintended perioperative hypothermia. Ochsner J. 2011; 11: p. 259-70.
5. Aubrun F, Gazon M, Schoeffler M, et al. Evaluation of perioperative risk in elderly patients. Minerva Anestesiol 2012; 78:605–18.
6. Leslie, K., Sessler, D. I. (2003). Perioperative hypothermia in the high-risk surgical patient. Best Practice & Research Clinical Anaesthesiology, 17(4), 485–498.
7. Cheng, S.-P., Yang, T.-L., Jeng, K.-S., Lee, J.-J., Liu, T.-P., & Liu, C.-L. (2007). Perioperative Care of the Elderly. International Journal of Gerontology, 1(2), 89–97.
8. Daabiss M. American Society of Anaesthesiologists physical status classification. Indian J Anaesth. 2011 Mar;55(2):111-5.
9. Sundararajan, V., Henderson, T., Perry, C., Muggivan, A., Quan, H., & Ghali, W. A. (2004). New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. Journal of Clinical Epidemiology, 57(12), 1288–1294.
10. Nasreddine, Z. S., Phillips, N. A., Bédirian, V., Charbonneau, S., Whitehead, V., Collin, I., Chertkow, H. (2005). The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment. Journal of the American Geriatrics Society, 53(4), 695–699.
11. Rockwood, K. (2005). A global clinical measure of fitness and frailty in elderly people. Canadian Medical Association Journal, 173(5), 489–495.
12. Epping-Jordan JE, Chatterji S, Ustun TB. The World Health Organization Disability Assessment Schedule II. (WHO DAS II): a tool for measuring clinical outcomes. Oral presentation, NIMH Mental Health Services Research Meeting, Washington, DC, July 2000.
13. Neary, W. D., Heather, B. P., & Earnshaw, J. J. (2003). The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM). British Journal of Surgery, 90(2), 157–165.
14. Sessler, C. N., Gosnell, M. S., Grap, M. J., Brophy, G. M., O’Neal, P. V., Keane, K. A., Elswick, R. K. (2002). The Richmond Agitation–Sedation Scale. American Journal of Respiratory and Critical Care Medicine, 166(10), 1338–1344.
15. Stark PA, Myles PS, Burke JA. Development and psycho- metric evaluation of a postoperative quality of recovery score: the QoR-15. Anesthesiology 2013; 118: 1332e40
16. Luis C, Moreno C, Silva A, Pascoa R, Abelha F. Inadvertent Postoperative hypothermia at post-anesthesia care unit: incidence, predictors and outcome. Open Journal of Anesthesiology,2012, 2,205-213.
17. Abelha F, Castro M, Neves A, Landeiro N, Santos C. Hypothermia in a surgical intensive care unit. BMC Anesthesiology 2005, 5:7.
18. McSwain JR, Yared M, Doty JW, Wilson SH. Perioperative hypothermia: Causes, consequences and treatment. World J Anesthesiol 2015; 4(3): 58-65
19. Bennett J, Ramachandra V, Webster J, Carli F. Prevention of hypothermia during hip surgery: effect of passive compared active skin surface warming. Br J Anaesth 1994; 73(2):180-3.
20. Belayneh T, Gebeyehu A, Abdissa Z. Post-operative hypothermia in surgical patients at university of Gondar Hospital, Ethiopia. J Anesth Clin Res, 2014, 5:11.
21. Gasim, G. I., Musa, I. R., Abdien, M. T., & Adam, I. (2013). Accuracy of tympanic temperature measurement using an infrared tympanic membrane thermometer. BMC Research Notes, 6(1), 194.
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