Preoperative Warming and Improved Postoperative Outcomes in Colorectal Surgical Patients

Abstract

Problem: The maintenance of normothermia during surgery is a critical component of patient care provided by the anesthesia provider. A root cause analysis revealed this Level II Trauma Center performed preoperative warming for hysterectomy patients, as part of an Enhanced Recovery After Surgery (ERAS) protocol. However, there were no established preoperative warming protocols for patients receiving colorectal surgery. Intraoperative hypothermia is associated with negative postoperative outcomes to include, increased risk of surgical site infection, increased intraoperative blood loss, increased narcotic requirement following surgery and prolonged hospitalization. If this problem was not addressed, patients could experience adverse postoperative outcomes leading to increased hospital costs and waste of resources. Purpose: To overcome the absence of standardization of preoperative warming for adult surgical patients at this facility, this project implemented a preoperative warming protocol for colorectal ERAS patients prior to surgery. Methods: The quality improvement project was implemented over a 15-week period in the fall of 2022. Change in practice occurred with the implementation of a preoperative warming protocol for colorectal surgical patients. The surgical team initiated the ERAS order set and the nurse initiated warming per protocol at least 30 minutes prior to surgery. The patient’s postoperative temperature in the post anesthesia care unit was also evaluated. Results: If the warming protocol was ordered by the colorectal surgery team 100% of patients received prewarming. Thirty-eight patients were eligible, but only 76% had an order present and received prewarming. All patients who received prewarming were normothermic postoperatively. Conclusion: Project findings cannot conclude if protocol implementation had an impact on patient outcomes at this facility. Patients who received prewarming were normothermic postoperatively. This is associated with improved postoperative outcomes and reduced hospital spending.