Impact of a thermal care bundle on peri-operative hypothermia, surgical site infection, and readmissions in osteosynthesis patients: A randomised controlled trial.

In 30 seconds

This open-label randomised controlled trial at a university hospital evaluated a thermal care bundle in 148 patients undergoing osteosynthesis. The bundle combined 10 minutes of prewarming, forced-air warming during surgery and immediate recovery, a 21 °C operating room, and warmed fluids. Hypothermia was less frequent with the bundle at surgery start (1.3% vs. 9.9% among controls) and PACU admission (14.3% vs. 29.6%). The bundle increased core temperature by 0.13 °C (95% CI, 0.003 to 0.254). Wound infections requiring readmission were numerically fewer, but the difference was not statistically significant.

Key findings

• At surgery start, hypothermia occurred in 1.3% of bundle patients versus 9.9% of controls (odds ratio = 7.59, P = 0.021).
• At PACU admission, hypothermia occurred in 14.3% of bundle patients versus 29.6% of controls (odds ratio = 2.07; P = 0.024).
• The bundle increased core body temperature by 0.13 °C (95% confidence interval (CI), 0.003 to 0.254; P = 0.045).
• Wound infections requiring readmission were numerically lower with the bundle (odds ratio = 0.35; 95% CI, 0.04 to 2.92), without a statistically significant difference (P = 0.332).

Why it matters

Peri-operative hypothermia is a preventable complication, and this trial found that a coordinated warming approach reduced its occurrence at two clinically relevant time points in osteosynthesis patients. The findings support attention to temperature management across preoperative, intraoperative, and immediate postoperative care. The study did not establish that the bundle reduces surgical site infection or readmission.

What to keep in mind

The trial was open-label and conducted at a single university hospital. The reported difference in wound infections requiring readmission was not statistically significant.