Running head: ADVERSE EFFECTS OF HYPOTHERMIA DURING SURGERY

Adverse Effects of Hypothermia During Surgery

Leslie Wiley
The Robert B. Miller College
SCIE 330 02
Mr. Rich Hansen, Instructor
December 8, 2013

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Adverse Effects of Hypothermia During Surgery

Introduction
Reimbursement for healthcare is becoming very complicated. Payment may be withheld,
or decreased in allowance amount, for many reasons. If a patient is re-hospitalized within a
certain time period the insurance companies will not pay for the second admission. Some
patients acquire nosocomial infections while in the hospital, thus affecting reimbursement, as
well as healing. If a surgical patient experiences complications such as infection or bleeding, it
will not only affect insurance reimbursement, but it is very harmful for the patient.
As healthcare providers, it is imperative that our priority be to strive for excellent care so
that our patients have the best outcomes. Not only will patients have satisfaction but the hospital
will be successful, thus job security for all employees. One area that should be monitored is a
patients body temperature while in surgery. If a patient experiences hypothermia on the
operating table there can be life threatening consequences. An increased risk of infection as well
as a higher risk for bleeding during surgery is a couple of adverse effects.
Statement of Main Problem
Some experts believe that when a person experiences a decrease in body temperature it
can increase bleeding while undergoing a surgical procedure. This can, sometimes, affect the
outcome of the surgery if the bleeding is excessive. Blood transfusions may need to be given
and there are risks associated with this. Maintaining the body temperature can be difficult when
operating rooms are kept fairly cool in order to keep bacteria down. Patients generally have
large parts of their bodies exposed making it difficult to maintain normothermia.

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The risk for infection can increase in surgical patients when a normal body temperature is
not consistent. Infection in surgical patients is costly to the hospital and the patient. It extends
hospital stay and causes a hardship to the patient and their families. There are many reasons that
a patient may become infected. However, if healthcare providers can prevent this by keeping the
body temperature normal while in surgery, it is in the patients best interest to do so.
Discussion of Subproblems
Increased bleeding can be hard to control and can have unwanted outcomes for surgical
patients. Every effort must be made to control factors that affect bleeding. Body temperature is
one of those. Along with increased bleeding comes a higher incidence of blood transfusion
which comes with its own set of risks.
Infection can be costly and have serious implications for patients. It often requires a
return to surgery, depending on what kind of infection and where it is at. By keeping body
temperature under control, health care workers can prevent surgical site infections.
Hypotheses
During a surgical procedure, hypothermia increases the risk for bleeding and raises the
chances of acquiring a surgical site infection.
Delimitations of Research

Pre-existing conditions will not be taken into account

Infections that are not surgical site
Bleeding caused by other complications
Patients with hyperthermia
Definitions of Key Terms

Nosocomial hospital acquired.

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Adverse effect harmful and undesired effect.

Hypothermia abnormally low body temperature.
Hyperthermia abnormally high body temperature.
Normothermia normal body temperature.
Assumptions
Hypothermia causes many adverse effects for patients undergoing surgery. I will follow
patients that go through elective surgeries. Based on their body temperature throughout the
procedure, the amount of blood loss will be monitored. When the temperature is decreased more
blood will be lost. Each patient will be monitored after surgery for a period of time to keep track
of infection rates. An infection that is associated with the surgical procedure must occur within
thirty days of surgery.
Importance of Study
Imagine lying on the operating room table, where it is cold and the nerves are rumbling in
your stomach. The only thing on your mind is hoping the surgery goes well. As a healthcare
worker, it is my job to help make that happen. I can offer warm blankets and hold your hand as
you go off to sleep. My job goes beyond that though. By maintaining a normal body
temperature for you, I can decrease the amount of blood that is lost and prevent a blood
transfusion or other complications. Sterile technique will be strictly adhered to prevent
infections. However, with a normal body temperature this will be easier to do. My number one
priority is to make sure that you wake up and recover as quickly as possible with no
complications. That means not returning to my operating room for something that can be
prevented by watching closely at body temperature.

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Literature Review
A large majority of the human population will experience a surgical procedure at least
once in their lifetime. The thought of surgery is scary for most people, especially after hearing
all the possibilities of what may happen during the procedure. Some of these complications are
uncontrollable on the surgeon and surgical staffs part. However, certain complications, such as
increased bleeding and a higher chance of postoperative infection as a result of hypothermia can
be prevented. Studies have shown that hypothermia during a surgical procedure has adverse
effects to the patient.
Hypothermia in the Surgical Setting
Life threatening consequences may occur as a result of hypothermia in the surgical suite.
Hypothermia is a core body temperature of 36 degrees Celsius and below (Wagner, 2010).
Research shows that 50-90% of surgical patients experience hypothermia during surgery
(Knaepel, 2012). There are many ways to combat this if education is placed on keeping our
patients warm during surgery. It is often unavoidable as a result of the environment as well as
the anesthetic drugs that are used to put the patient to sleep. Anesthesia affects the bodys ability
to regulate temperature, therefore, causing hypothermia. Muscles relaxants are used to paralyze
the patient for surgery and this decreases the bodys ability to shiver affecting core body
temperature (Burger and Fitzpatrick, 2009). The environment in the surgical suite is cold in
order to keep bacteria from growing. It also helps keep the surgeon and surgical technologists
cool while they are scrubbed in under the hot lights. There is also a loss of heat due to
evaporation from open body cavities (Journeaux, 2013). For example, if a patient is having
abdominal surgery the entire abdomen from sternum to thighs is exposed. This is harder to
control than a patient having foot surgery. In that case, only the operative leg will be exposed.

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Adverse Effects of Hypothermia

There are many adverse effects or complications as a result of intra-operative
hypothermia. Two serious complications that are studied in this research analysis are increased
bleeding and increased risk of postoperative infection. Both bleeding and the increased infection
risk can be prevented or greatly reduced by educating and bringing awareness to surgical and
anesthesia staff. Addressing the first complication, bleeding, studies showed that hypothermic
patients had an average of eight units of blood transfused compared to one unit in the
normothermic group (Knaepel, 2012). This is a huge difference in the number of blood
transfusions. Blood transfusions have risks associated with them so preventing this at all costs is
essential to patient care.
Postoperative infections are disastrous to the patient and cost the hospital a lot of money
not to mention a bad reputation. Some of these infections are avoidable. In a study of 200
patients there was a 19% rate of surgical wound infection in hypothermic patients as opposed to
a 6% rate in normothermic patients (Knaepel, 2012). Another study showed that a temperature
of just 2 degrees C below normal triples the incidence of wound infection (Burger and
Fitzpatrick, 2009). There are a lot of products available to help keep patients warm. However,
these products cost money so hospitals tend to defer. However, the cost of an infection is very
costly to the hospital and the warming products would pay for themselves. Patients that develop
a surgical site infection have to stay, on average, one week longer in the hospital (Sessler and
Akca, 2002).
Prevention of Hypothermia

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There are many ways to prevent hypothermia in the surgical setting. Continuing to
educate surgeons, surgical staff, and anesthesia is imperative. Warming units have shown
effective as a way to warm patients while asleep on the operating table. The most common
method of warming surgical patients is forced-air convection. Forced-air convection systems
consist of a blower that delivers electrically heated air into a quiltlike cover (Sessler and Akca,
2002). These quilt like covers come in multiple sizes such as an upper body that covers just the
chest and arms or a lower body cover that keeps the lower half of the body warm. Some
facilities use the method of pre-warming by giving multiple warm blankets and keeping them
covered at all times. This occurs in the preoperative setting before the patient enters the surgical
suite. Once in the operating room more blankets are given before the patient goes to sleep.
While some may not consider hypothermia to be a big deal, the slightest decrease in core
body temperature can be detrimental to patients. The complications can be life threatening to the
patient and be very costly to the hospital. Maintaining a normal body temperature is obtainable
by implementing certain policies and procedures. It will benefit everyone involved to be
conscious of the patients temperature while in the surgical suite.

Methodology
Data needed and the means for obtaining data

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All data necessary for the study of increased postoperative infection and increased
bleeding as a result of hypothermia while undergoing surgery will be obtained from the
documentation of all voluntary participating patients. The study will take place for ninety days.
Informed consent will be obtained by the researcher from each patient willing to participate in
the study within the ninety day time period. Each willing participant will be given a number for
identification purposes. This will be used by the researcher only so that thirty days postoperative
the data can be matched back to the correct patient. The study will take place at Bronson Battle
Creek in the surgical services department. Data will be gathered after the patients surgery is
completed and the researcher will follow that patient for thirty days postoperatively to watch for
infection. The researcher will study body temperature, laboratory values such as hemoglobin to
detect blood loss and white blood cell counts to measure infection as well as replacement of
blood products during surgery.
The process
On the day of surgery, each patient will be visited by the researcher and an explanation
will be given for the study. All willing participants will be given a consent form to be signed.
This will give permission for the researcher to use all data from the surgical procedure, excluding
the patients name and birth date. See Appendix A for a copy of the consent form. Surgical staff
and anesthesia personnel will not be aware of patients that are participating in the study so as not
to perform their jobs differently than their normal scope of practice. Surgery will be performed
in the usual fashion. The patient will be discharged to the floor for all inpatient surgeries or
discharged home for all outpatient procedures. The following week, after all surgical and
anesthesia documentation has been completed, the researcher will spend time analyzing and
pulling data from each participating patients charts. Each patients body temperature range will

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be recorded. From there the researcher can assess the preoperative hemoglobin versus the
postoperative hemoglobin to see how much blood was lost. Blood transfusions will be recorded
as well. At the end of the ninety day period, the hemoglobin levels and body temperature will be
combined on a chart to show that the lower the body temperature fell during surgery the lower
the hemoglobin levels are, indicating a greater blood loss. All patients participating in the study
will agree to have a follow up lab draw at thirty days post procedure to see what their white
blood cell count is. At that time the incision site will be evaluated for signs of infection. All data
will be recorded and a chart will be included showing the body temperatures during surgery and
if the patient incurred a postoperative infection.
Privacy and data storage
The patient will be assigned a number by the researcher. A master list will be kept in a
locked cabinet that indicates each patients assigned number and their personal information. This
will be used only by the researcher in order to complete the thirty day postoperative infection
evaluation. At the end of the study the master list will be destroyed as well as any other personal
information needed for the completion of the study.

Appendix A

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I, ____________________________, give my consent to participate in the research study

conducted at Bronson Battle Creek in the surgery department. I have been informed of the study
and all of my questions were answered. I understand that my personal information will not be
shared in the study. I agree to be followed and evaluated in thirty days from the date of surgery
for a blood draw and evaluation of my surgical site incision.

Signature____________________________

Witness______________________________

Researcher___________________________

Patient identification number_____________

Date__________________

Resources

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Burger, L., & Fitzpatrick, J. (2009). Prevention of inadvertent perioperative hypothermia. British
Journal of Nursing, 18(18), 1114-1119. Retrieved from EBSCO.
Journeaux, M. (2013, July 10). Peri-operative hypothermia: implications for practice [Electronic
version]. Nursing Standard, 27(45), 33-38.
Knaepel, A. (2012, March). Inadvertent peri-operative hypothermia: a literature review
[Electronic version]. Journal of Perioperative Practice, 22(3), 86.
Sessler, D. I., & Akca, O. (2002, November 13). Nonpharmacological prevention of surgical
wound infections. healthcare epidemiology, 1397-1404. Retrieved October 1, 2013, from
EBSCO.
Wagner, D. (2010, November). Patient safety chiller: unplanned perioperative hypothermia
[Electronic version]. AORN Journal, 92(5), 567-571. doi:10.1016/j.aron.2010.07.013

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