3.6 Effect of perioperative strategies that minimise blood loss

3.6.2 Prevention of hypothermia

The detailed findings of the systematic review for this intervention can be found in Section 3.6.1 of Volume 1b of the technical report.4 The literature search identified three Level I systematic reviews149–151 and five Level II studies152–156 – of varying quality – examining the effect of hypothermia prevention strategies during surgery.

Transfusion requirements and blood loss

Meta-analyses of the treatment effect reported in Level I and II studies indicated that use of hypothermia prevention strategies resulted in significant reductions in transfusion incidence (22%) and blood loss (14%).

Morbidity

One RCT found that hypothermia prevention during surgery significantly reduced the risk of morbid cardiac events and wound infection.151 Another RCT found that the rate of wound infection was significantly lower in patients who were warmed preoperatively.154

EVIDENCE STATEMENTS – prevention of hypothermia	Evidence	Consistency	Clinical impact	Generalisability	Applicability
In adult patients undergoing surgery in which substantial blood loss is anticipated, the prevention of hypothermia reduces the incidence of transfusion.
In adult patients undergoing surgery in which substantial blood loss is anticipated, the prevention of hypothermia may reduce the volume of transfusion.			X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the prevention of hypothermia reduces blood loss.
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of the prevention of hypothermia on mortality is uncertain.		NA	X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the prevention of hypothermia reduces the incidence of wound infection.
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of the prevention of hypothermia on quality of life is unknown.	NA	NA	NA	NA	NA
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of the prevention of hypothermia on haemoglobin concentration is uncertain.			X		X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of the prevention of hypothermia on length of hospital stay is uncertain.			NA	X
In adult patients undergoing surgery in which substantial blood loss is anticipated, the effect of the prevention of hypothermia on length of intensive care unit stay is uncertain.			NA	X

(See Table 2.2)

RECOMMENDATION – prevention of hypothermia

R12 Grade A	In patients undergoing surgery, measures to prevent hypothermia should be used (Grade A).