The Warming Management Measures May Need to Be Further Enhanced During Scoliosis Correction and Internal Fixation Surgery: A Retrospective Cohort Study.

Abstract

The incidence of intraoperative hypothermia (IPH) exceeds 70% during spinal surgery, which can lead to many adverse outcomes, including increased intraoperative blood loss/transfusion and delayed recovery. We aimed to evaluate the comprehensive efficiency of a kind of enhanced warming measure on patients undergoing spinal surgery. A retrospective analysis was conducted on the clinical data, surgical procedures, and outcomes of consecutive patients admitted to the department of orthopedics of a hospital from December 2019 to May 2023 and undergoing spinal surgery (scoliosis correction and internal fixation surgery). The impact of the perioperative warming measures on surgical temperature variation and postoperative recovery was analyzed. The surgical patients who received normal active warming measures (quilt, blood transfusion and infusion warming, flushing fluid warming) were the control group (Normal Warming Group [NWG], n = 199), and the enhanced active warming measures (NWG and forced air warming) were the experimental group (Enhanced Warming Group [EWG], n = 201). Incidence of IPH was the primary endpoint of this study. EWG exhibited a significantly reduced incidence of IPH and average frequency of hypothermia per patient compared with NWG (respectively, p < 0.01) and demonstrated notable reductions in intraoperative blood loss, urine output, anesthesia recovery time, and duration of arousal (respectively, p < 0.05, p < 0.01, and p < 0.001). Postoperatively, EWG showed a significantly reduced incidence of shivering (p < 0.001) and had lower costs for postoperative antibiotic use and albumin administration (respectively, p < 0.05 and p < 0.01). So we infer that the occurrence of hypothermia during spinal surgery may seem unavoidable, but EWG can effectively lower the occurrence of IPH and its adverse outcomes, and then somewhat alleviate the postoperative treatment burden. However, given that this study is a retrospective cohort study, it is not yet possible to definitively prove the above conclusions, so we will design relevant prospective clinical studies to prove that the optimization of temperature management may be crucial to ensure optimal overall recovery outcomes.