Association between normothermia at the end of surgery and postoperative complications following orthopedic surgery

Koji Yamada, Koji Nakajima, Hideki Nakamoto, Kazuhiro Kohata, Tomohiro Shinozaki, Hiroyuki Oka, Kiyofumi Yamakawa, Takuya Matsumoto, Fumiaki Tokimura, Hiroyuki Kanai, Yujiro Takeshita, Tatsuro Karita, Yasuhito Tajiri, Hiroshi Okazaki, Sakae Tanaka

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background. Maintaining perioperative normothermia is recommended by recent guidelines for the prevention of surgical site infections (SSIs). However, the majority of supporting data originates outside the field of orthopaedic surgery. Methods. The effect of normothermia was explored using the prospectively collected data of consecutive patients who underwent single-site surgery in 7 tertiary referral hospitals between November 2013 and July 2016. SSIs, urinary tract infections (UTIs), respiratory tract infections (RTIs), cardiac and cerebral events (CCE), and all-cause mortality rates within 30 days after surgery were compared between patients with normothermia (body temperature ≥36°C) and those with hypothermia (<36°C) at the end of surgery, after closure. Multivariable adjusted and inverse-probability weighted regression analyses were performed. Results. The final cohort included 8841 patients. Of these, 11.4% (n = 1008) were hypothermic. More than 96% were evaluated in person by the physicians. After adjusting for multiple covariates, normothermia was not significantly associated with SSIs (adjusted odds ratio [aOR] 1.18, 95% confidence interval [CI], UTIs (aOR 1.14, 95% CI, RTIs (aOR 0.60, 95% CI 0.31. 1.19), or CCE (aOR 0.53, 95% CI In contrast, normothermia was associated with a lower risk of 30-day mortality (aOR 0.26, 95% CI; P < .01; weighted hazard ratio 0.21, 95% CI; P = .002). In a subgroup analysis, normothermia was associated with reduced mortality in all types of surgical procedures. Conclusions. Whereas our findings suggest no clear association with SSI risks following orthopedic surgery, our study supports maintaining perioperative normothermia, as it is associated with reduced 30-day mortality.

Original languageEnglish
Pages (from-to)474-482
Number of pages9
JournalClinical Infectious Diseases
Issue number3
Publication statusPublished - 1 Feb 2020


  • Mortality
  • Normothermia
  • Orthopedic surgery
  • Surgical site infection

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