Reducing implant infection in orthopaedics (RIIiO): results of a pilot study comparing the influence of forced air and resistive fabric warming technologies on post-operative infections following orthopaedic implant surgery

Kümin, M, Deery, J, Turney, S, Price, C, Vinayakam, P, Smith, A, Filippa, A, Wilkinson-Guy, L, Moore, F, O'Sullivan, M, Dunbar, M, Gaylard, J, Newman, J, Harper, C M, Minney, D, Parkin, C, Mew, L, Pearce, O, Third, K, Shirley, H, Reed, M, Jefferies, L, Hewitt-Gray, J, Scarborough, C, Lambert, D, Jones, C I, Bremner, S, Fatz, D, Perry, N, Costa, M and Scarborough, M (2019) Reducing implant infection in orthopaedics (RIIiO): results of a pilot study comparing the influence of forced air and resistive fabric warming technologies on post-operative infections following orthopaedic implant surgery. Journal of Hospital Infection. ISSN 0195-6701

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Abstract

BACKGROUND
Active warming during surgery prevents perioperative hypothermia but the effectiveness and post-operative infection rates may differ between warming technologies. We report results of a pilot study in patients over the age of 65 undergoing hemiarthroplasty following fractured neck of femur.
AIM
To establish the recruitment and data management strategies needed for a full trial comparing post-operative infection rates associated with forced air versus resistive fabric warming.
METHODS
Participants were randomised 1:1 in permuted blocks to forced air or resistive fabric warming. Hypothermia was defined as a temperature of <36ºC at the end of surgery. Primary outcomes were the number of participants recruited and the number with definitive deep surgical site infections.
FINDINGS
515 participants were randomised at 6 sites over a period of 18 months. Follow-up was completed for 70.1%. Thirty-seven participants were hypothermic (7.5% in the FAW group; 9.7 % in the RFW group). The mean temperatures before anaesthesia and at the end of surgery were similar. For the primary clinical outcome, there were 4 deep surgical site infections in the forced air warming group and 3 in the resistive fabric warming group. All participants who developed a post-operative infection had antibiotic prophylaxis, a cemented prosthesis and were operated under laminar airflow; none were hypothermic. There were no serious adverse events related to warming.
CONCLUSION
Surgical site infections were identified in both groups. Progression from the pilot to the full trial is possible but will need to take account of the high attrition rate.
TRIAL REGISTRATION
ISRCTN 74612906 (http://www.isrctn.com/ISRCTN74612906).

Item Type: Article
Keywords: Infection, Forced Air Warming, Resistive Fabric Warming
Schools and Departments: Brighton and Sussex Medical School > Primary Care and Public Health
Subjects: R Medicine
R Medicine > RD Surgery
Depositing User: Chris Jones
Date Deposited: 25 Sep 2019 14:56
Last Modified: 28 Oct 2019 08:15
URI: http://sro.sussex.ac.uk/id/eprint/86174

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Project NameSussex Project NumberFunderFunder Ref
UnsetUnsetHealthcare Infection SocietyUnset
UnsetUnset3MUnset
UnsetUnsetNuffield Benefaction for MedicineUnset
UnsetUnsetWellcome Institutional Strategic Support Fund (ISSF) at Oxford UniversityUnset