Prevention of inadvertent perioperative hypothermia as a quality indicator in anesthesia: an eight-year experience from 2014 to 2022.

backgroundInadvertent perioperative hypothermia remains one of the most common yet undertreated complications in anesthesia practice. Although evidence-based guidelines for its prevention have long been available, a significant gap persists between existing knowledge and clinical implementation. This study reports an eight-year institutional experience in which perioperative hypothermia was adopted as a quality indicator and managed through a collaborative framework between the anesthesiology department and the hospital quality management unit.

methodsA single-center, retrospective quality improvement study was conducted between May 2014 and September 2022. Adult patients who underwent surgery lasting more than four hours under general anesthesia were included. Postoperative body temperature was measured by tympanic infrared thermometry upon admission to the recovery unit; values below 36 °C were recorded as hypothermia. A Plan, Do, Check, Act (PDCA) cycle was employed in four phases: problem identification and baseline data collection (2014), awareness and education interventions (2014-2015), structural and technical improvements including provision of tympanic thermometers to all operating rooms and standardization of forced-air warming protocols (2015-2016), and continuous monitoring with periodic reinforcement (2016-2022). Data were collected monthly during 2014-2016 and through a sampled audit of one representative month per quarter from 2017 onward. Trends were analyzed using a Cochran, Armitage test and grouped binomial logistic regression, and process stability with a statistical process control chart.

resultsA total of 1,902 patients were evaluated over the study period, of whom 348 (18.3%) were found to be hypothermic postoperatively. The annual hypothermia rate was 32.5% in 2014, falling to 25.9% in 2015 and 15.2% in 2016 following the educational and structural interventions. From 2017 to 2022, rates stabilized between 9.7% and 15.1%, representing an approximate 3.2-fold reduction from baseline. The decreasing trend was statistically significant (Cochran, Armitage p < 0.001; odds ratio 0.806 per year, 95% CI 0.762, 0.852). Intermittent spikes were observed in isolated quarters (e.g., 32.4% in the third quarter of 2019), but targeted re-education sessions led to prompt correction. The lowest annual rate recorded was 9.7% in 2021.

conclusionSystematic identification and monitoring of perioperative hypothermia as a quality indicator, coupled with relatively straightforward interventions (education, equipment provision, and ongoing surveillance), was associated with a substantial and sustained reduction in hypothermia rates over eight years. Active collaboration between the quality management unit and the anesthesiology department, with a designated physician serving as quality representative, appeared central to sustaining these gains. These findings suggest that a structured, PDCA-based quality improvement approach may help bridge the gap between established guidelines and day-to-day clinical practice, even without large-scale resource investment; as a single-center experience, this should be regarded as a working hypothesis requiring multi-site confirmation.