Incidence of perioperative inadvertent hypothermia and compliance with evidence-based recommendations at four Australian hospitals: a retrospective chart audit

Perioperative inadvertent hypothermia (PIH) significantly increases a patient's risk of adverse complications such as surgical site infection; morbid cardiac events; and surgical bleeding. A retrospective chart audit of 400 patients was conducted to identify the incidence of PIH and compliance with evidence-based recommendations at four Australian hospitals. Patients were excluded from the audit if they were pregnant, under 18 years of age, had impaired thermoregulation, therapeutic hypothermia, or local anaesthesia only. Trained auditors extracted data on the incidence of PIH, compliance with evidence-based recommendations, and patient characteristics. Of the 350 patients who met the inclusion criteria, the mean age was 56 (SD 19). The majority (74%, n=260) had elective surgery with orthopaedic procedures, the most common surgical type (28%, n=98). The incidence of PIH in the population was 32% (n=101) and the lowest recorded temperature was 34.0 C. Eighty per cent (n=280) of patients did not have a temperature documented intraoperatively and only 8.8% (n=29) had at least one documented temperature for each perioperative phase (pre-, intra-, and postoperative). Forty five per cent (n=133) of intraoperative patients and 77% (n=97) of postoperative patients did not receive active warming when indicated. Contrary to recommended practice, 47% (n=137) of patients were hypothermic at discharge from the post-anaesthetic recovery unit (PARU). This audit revealed poor compliance with evidencebased recommendations, which may have contributed to the significant number of patients who experienced PIH. Further research must be undertaken to identify the potential barriers to appropriate PIH prevention and identify strategy to translate the evidence into clinical practice.