Evaluation of Postoperative Warming Care Protocol for Thermal Comfort and Temperature Management Immediately After Surgery: Nonrandomized Controlled Trial

Intraoperative thermostatic nursing and failure mode and effects analysis enhance gastrectomies' care quality

BACKGROUND

Utilizing failure mode and effects analysis (FMEA) in operating room nursing provides valuable insights for the care of patients undergoing radical gastric cancer surgery.

AIM

To evaluate the impact of FMEA on the risk of adverse events and nursing-care quality in patients undergoing radical surgery.

METHODS

Among 230 patients receiving radical cancer surgery between May 2019 and May 2024, 115 were assigned to a control group that received standard intraoperative thermoregulation, while the observation group benefited from FMEA-modeled operating room care. Clinical indicators, stress responses, postoperative gastrointestinal function recovery, nursing quality, and the incidence of adverse events were compared between the two groups.

RESULTS

Significant differences were observed in bed and hospital stay durations between the groups (P < 0.05). There were no significant differences in intraoperative blood loss or postoperative body temperature (P > 0.05). Stress scores improved in both groups post-nursing (P < 0.05), with the observation group showing lower stress scores than the control group (P < 0.05). Gastrointestinal function recovery and nursing quality scores also differed significantly (P < 0.05). Additionally, the incidence of adverse events such as stress injuries and surgical infections varied notably between the groups (P < 0.05).

CONCLUSION

Incorporating FMEA into operating room nursing significantly enhances patient care by improving safety, expediting recovery, and reducing healthcare-associated risks.

Inadvertent perioperative hypothermia and surgical site infections after liver resection

BACKGROUND

In the overall surgical population, inadvertent perioperative hypothermia has been associated with an increased incidence of surgical site infection (SSI). However, recent clinical trials did not validate this notion. This study aimed to investigate the potential correlation between inadvertent perioperative hypothermia and SSIs following liver resection.

METHODS

This retrospective cohort study included all consecutive patients who underwent liver resection between January 2019 and December 2021 at the First Affiliated Hospital, Zhejiang University School of Medicine. Perioperative temperature managements were implemented for all patients included in the analysis. Estimated propensity score matching (PSM) was performed to reduce the baseline imbalances between the normothermia and hypothermia groups. Before and after PSM, univariate analyses were performed to evaluate the correlation between hypothermia and SSI. Multivariate regression analysis was performed to determine whether hypothermia was an independent risk factor for postoperative transfusion and major complications. Subgroup analyses were performed for diabetes mellitus, age > 65 years, and major liver resection.

RESULTS

Among 4000 patients, 2206 had hypothermia (55.2%), of which 150 developed SSI (6.8%). PSM yielded 1434 individuals in each group. After PSM, the hypothermia and normothermia groups demonstrated similar incidence rates of SSI (7.0% vs. 6.3%, P = 0.453), postoperative transfusion (13.7% vs. 13.3%, P = 0.743), and major complications (10.1% vs. 9.0%, P = 0.309). Univariate regression analysis revealed no significant effects of hypothermia on the incidence of SSI in the group with the highest hypothermia exposure [odds ratio (OR) = 1.25, 95% confidence interval (CI): 0.84-1.87, P = 0.266], the group with moderate exposure (OR = 1.00, 95% CI: 0.65-1.53, P = 0.999), or the group with the lowest exposure (OR = 1.11, 95% CI: 0.73-1.65, P = 0.628). The subgroup analysis revealed similar results. Regarding liver function, patients in the hypothermia group demonstrated lower γ-glutamyl transpeptidase (37 vs. 43 U/L, P < 0.001) and alkaline phosphatase (69 vs. 72 U/L, P = 0.016). However, patients in the hypothermia group exhibited prolonged activated partial thromboplastin time (29.2 vs. 28.6 s, P < 0.001).

CONCLUSIONS

In our study of patients undergoing liver resection, we found no significant association between mild perioperative hypothermia and SSI. It might be due to the perioperative temperature managements, especially active warming measures, which limited the impact of perioperative hypothermia on the occurrence of SSI.