Mahoney C B, Odom J
University of Minnesota, Carlson School of Management, Minneapolis, USA.
AANA J. 1999 Apr;67(2):155-63.
The present study used a meta-analysis to examine 4 questions about intraoperative hypothermia. The questions addressed were as follows: (1) Is the difference in adverse patient outcomes between normothermic and mildly hypothermic patient groups significant across studies and within studies? (2) What is the magnitude of the difference in adverse patient outcomes across studies? (3) What are the costs resulting from the difference in adverse patient outcomes? (4) Does a significant difference exist in effectiveness of modality for maintaining intraoperative normothermia? The results of this meta-analytic study provide evidence that the difference in adverse patient outcomes between the normothermic and mildly hypothermic patients is significant across studies for all adverse outcomes examined. The magnitude of this difference and the costs resulting from these adverse outcomes are presented. In addition, a significant difference in effectiveness between warming modalities for maintaining intraoperative normothermia was found. A significant increase in the risk of costly complications occurred when patient temperatures dropped a mean of 1.5 degrees C. For example, patients who become mildly hypothermic are much more likely to receive blood transfusions and to develop infections; both of these outcomes result in increased costs. Minimizing adverse outcomes is critical to cost-effective patient care in today's competitive healthcare environment. The cost of preventing intraoperative hypothermia is much less than the cost of treating the adverse outcomes that affect patients experiencing intraoperative hypothermia. Meta-analytic results allowed us to conclude that hypothermia averaging only 1.5 degrees C less than normal resulted in cumulative adverse outcomes adding between $2,500 and $7,000 per surgical patient to hospitalization costs across a variety of surgical procedures. In conclusion, patients whose temperatures have been maintained at normal levels during the intraoperative period experience fewer adverse outcomes, and their overall hospital costs are lower. Intraoperative normothermia is maintained more effectively with the use of forced air warming.
本研究采用荟萃分析来探讨关于术中低体温的4个问题。所涉及的问题如下：（1）在各项研究以及研究内部，体温正常和轻度低体温患者组之间不良患者结局的差异是否显著？（2）各项研究中不良患者结局的差异程度有多大？（3）不良患者结局差异所导致的成本是多少？（4）维持术中正常体温的方式在有效性上是否存在显著差异？这项荟萃分析研究的结果表明，对于所有所研究的不良结局，在各项研究中体温正常和轻度低体温患者之间的不良患者结局差异是显著的。呈现了这种差异的程度以及这些不良结局所导致的成本。此外，发现维持术中正常体温的保暖方式在有效性上存在显著差异。当患者体温平均下降1.5摄氏度时，发生代价高昂并发症的风险显著增加。例如，体温轻度低体温的患者更有可能接受输血并发生感染；这两种结局都会导致成本增加。在当今竞争激烈的医疗环境中，将不良结局降至最低对于具有成本效益的患者护理至关重要。预防术中低体温的成本远低于治疗术中发生低体温患者所出现的不良结局的成本。荟萃分析结果使我们能够得出结论，平均体温比正常体温低仅1.5摄氏度的低体温会导致累积不良结局，使各种外科手术的每位手术患者的住院成本增加2500美元至7000美元。总之，术中体温维持在正常水平的患者不良结局较少，且其总体住院成本较低。使用强制空气保暖能更有效地维持术中正常体温。
