Patient warming key in robotic surgery

Alliance Hospital, located in Odessa, TX, is garnering acclaim as one of the nations' leaders in the use of robotics technology in off-pump cardiac bypass surgeries (OPCBS). This modern, 167,000 square-foot facility houses six operating rooms, three cath labs, and over fifty beds. But the real highlight is Alliance's commitment to using state-of-the-art equipment. One of the first endoscopic heart surgeries using robotics was performed by Alliance Hospital Chairman Dr. Sudhir P. Srivastava, a world-class cardiovascular surgeon practicing in Odessa.

Dr. Srivastava and members of his team, anesthesiologist Dr. Michael Jones, and OR Nurse Krissy Hamilton, discuss the importance of having the right combination of tools to optimize patient outcomes during robotics surgery, and specifically, maintaining proper body temperature during and after surgery.

Role of patient warming in robotic surgery

The robotics surgeries that we practice are a new evolution in heart surgery. The use of robotics in surgery offers many advantages for the patient as well as the surgical team including more precise cuts, improved dexterity, increased range of motion and less bleeding. While robotics surgery allows for a more minimally invasive procedure, the surgery is longer in duration so maintaining normothermia is essential.

Its benefits, however, can only be fully realized when the rest of the equipment performs as expected. The need to prevent hypothermia during the surgery and maintaining proper temperature during recovery is still a significant consideration.

During on-pump surgeries, the body's temperature can be maintained through warmed infusions that are part of the on-pump technology. But off-pump requires other techniques to keep the body from drifting to temperatures that make the heart irritable. When that happens, usually below 34[degrees]C, the heart can spontaneously fibrillate, and that compromises the surgeon's surgical tactics, especially when using robotics. Also, the extra energy that it takes a patient to warm themselves after becoming hypothermic compromises rapid extubation, and slows clotting times, both important to successful post-operative outcomes.

As recently as five years ago, the temperature management technology available to us was simply not as efficacious as our current technology. As surgeries have moved from on-pump to off-pump, new patient warming therapies needed to be developed. For on-pump, where the body can be warmed as part of the on-pump procedures, it is somewhat easier to maintain normothermia. With off-pump, we first tried adjusting OR suite temperatures, which made the surgical team extremely uncomfortable and could divert their focus, and introduced air blankets which were bulky, and more importantly, increased the chance of contaminants being blown into the surgical field.

Case for direct conduction

After trying various combinations of temperature management tactics, we decided that direct conduction was the best fit for our robotic, OPCAB surgeries. The Kimberly-Clark Patient Warming System uses micro-channels of warm water pushed through a highly conductive pad that are applied to parts of the body that don't limit our access to the surgical site.

Our OR nursing team likes the fact that the system is easy to use. The control module monitors patient temperature by automatically adjusting the temperature of water circulation through the non-sterile, hydrogel transfer pads positioned on the patient's back. An added benefit, and it's not a small one to our team, is the quietness of the components which allows us to keep our focus. Other kinds of systems, especially the ones that blow air, create enough noise that it can affect your concentration over a long period of time.

Through our use of the Kimberly-Clark Patient Warming System, we can take the problems associated with hypothermia out of the equation and focus our attention elsewhere.

Improved outcomes

Beyond the OR, we have found that opportunities for improved outcomes often occur in recovery units such as PACU and CVICU where we see reduced recovery times, less shivering complications, reduced chance for cardiac arrythmia, and less mechanical ventilation time for the patient. Through a smoother recovery experience, our facility can also recognize significant cost-savings opportunities which are mostly related to time on ventilator, time in ICU and total hospital, blood product usage, wound infection and reoperations for bleeding.

According to Mahoney and Odom's recta-analysis of outcomes with costs, the incidence of nosocomial wound infections was reduced by 64% in patients who were maintained at normothermic temperatures. It was also estimated that the cost savings per patient with reduced surgical wound infections was between $545 and $1,697.

The negative impacts of hypothermia are amplified by the difficult recovery due to complex surgery. The body has been put under enormous stress for the surgery, therefore, the additional stress of overcoming a state of hypothermia can be more difficult for these patients.

Studies have shown that when patients are hypothermic when coming out of the OR, they run a higher risk of mortality, increased time on the ventilator, and use more packed red blood cells leading to higher levels of transfusion and longer lengths of hospital stays. We've found that paying attention to the thermoregulation of complex surgery patients, pays dividends directly to the patient first, and subsequently can improve many areas of care within the hospital. HPN

The Hospital

Alliance Hospital, Odessa, TX

The Problem

Alliance needed a patient warming system that was easy-to-use, effective and physician friendly

The Solution

Improved outcomes with a direct conduction warming system that saved time and money

The Vendor

Kimberly-Clark Health Care

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