Does perioperative hypothermia after primary total hip and knee arthroplasty affect acute outcomes?

Abstract

Intraoperative hypothermia (HT) is commonly experienced among patients undergoing total joint arthroplasty (TJA) and may be associated with increased blood loss, pain, and complications. Our study evaluated acute outcomes of patients with and without HT after primary total hip (THA) and knee arthroplasty (TKA). We identified 220 postoperative HT TJA cases (119 THAs and 101 TKAs) at a single institution as defined by a body temperature of <96.8° Fahrenheit (F) immediately in the post-anesthesia care unit (PACU). Cases were matched to non-hypothermia (NHT) controls 1:2 based on procedure type, age, sex, and body mass index. Intraoperative, immediate PACU, and 90-day outcomes were compared, including vital signs, blood loss, pain scores, opioid use, length of stay (LOS), complications, reoperations, Hip Osteoarthritis Outcome Score, Jr (HOOS), and Knee Osteoarthritis Outcome Score, Jr (KOOS). HT patients after THA and TKA did not experience significant differences in immediate PACU or hospital-based outcomes, including vital signs, pain scores, opioid consumption, LOS, or home discharge (<i>P</i> ≥ 0.1). Additionally, there were no differences in readmissions, VTEs, or HOOS/KOOS at 90 days (<i>P</i> ≥ 0.2). Although not statistically significant, HT THA patients trended toward more reoperations compared to NHT (5 versus 1.7 %, respectively, <i>P</i> = 0.08), but not for TKA (<i>P</i> = 0.5). Wound debridement for debridement for superficial wound dehiscence was the most common reoperation in HT cohorts. TJA patients experiencing perioperative HT do not have clinically significant different acute recovery and 90-day outcomes compared to NHT controls. While surgical patient normothermia remains important, both anesthetic and surgical considerations should be factored into determining the most optimal operating room temperature.