The Effects of Intraoperative Hypothermia in Surgical Hip Fracture Patients

Data presented Wednesday indicate an association between mean intraoperative hypothermia and the incidence of deep surgical site infections (DSSIs) in patients undergoing surgical fixation of hip fractures. Additionally, increased age and low body mass index (BMI) are possible risk factors for intraoperative hypothermia in these patients. 

According to coauthor Andrew M. Pepper, MD, the study was the largest series to analyze intraoperative hypothermia and its effect on surgical hip fracture patients. “Limited data are available regarding intraoperative hypothermia in orthopaedic patients,” he said. “Our study provides early information regarding hypothermia’s effects on patients with hip fractures and highlights the need for further study of this topic.”

Retrospective study
Dr. Pepper and his fellow researchers conducted a retrospective chart review of 1,525 consecutive patients who sustained surgical hip fractures (OTA 31-A1-3, 31-B1-3) at a Level 1 trauma center between January 2005 and October 2013. Polytrauma patients were excluded. All patients were older than age 75 and had similar demographics.

Among the 1,525 patients, 974 (63.8 percent) had sustained an intertrochanteric (IT) femur fracture; 551 (36.2 percent) had sustained a femoral neck (FN) fracture. Surgical treatment of IT fractures included the following:

  • cephalomedullary nail (CMN) (n= 802)
  • sliding hip screw (SHS) (n = 162)
  • intramedullary nail (n = 10)
  • Surgical treatment of FN fractures included the following:
  • hemiarthroplasty (n = 398)
  • closed reduction and percutaneous pinning (CRPP) (n = 85)
  • SHS (n = 50)
  • CMN (n = 13)
  • total hip arthroplasty (n = 4)
  • Girdlestone femoral head resection arthroplasty (n = 1)

A warmed-air convection active rewarmer was used to manage intraoperative temperature in 73.3 percent of hip fracture patients; the incidence of intraoperative hypothermia (< 36° C) was 13.2 percent. The researchers identified low BMI as a possible risk factor for intraoperative hypothermia and noted that intraoperative hypothermia was associated with DSSI.

Dr. Pepper’s coauthors of “Intraoperative Temperature in Hip Fractures: Effect on Complications and Outcome,” are Nicholas B. Frisch MD, MBA; Toufic R. Jildeh, BS; Jonathan H. Shaw, BS; Edward Peterson, PhD; S. Trent Guthrie, MD; and Craig Silverton, DO.

Details of the authors’ disclosures as submitted to the Orthopaedic Disclosure Program can be found in the Final Program; the most current disclosure information may be accessed electronically at www.aaos.org/disclosure

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