#25 – Preventing Hypothermia in Arthroplasty Surgery with Brian McGrory, MD

My guest today is Dr Brian McGrory.  His is an orthopedic joint replacement surgeon at Maine Medical Center in Portland, Maine.    He earned his bachelor’s degree in chemistry biology at Cornell, attended medical school at Columbia, followed by residency in orthopedic surgery at the Mayo Clinic Graduate School where he also earned a Master’s degree in orthopedic research.  Dr McGrory then completed a fellowship through Harvard University at Massachusetts General Hospital in adult hip & knee reconstruction.  He has served as the research director for orthopedics at Maine Medical Center and the founding editor-in-chief of Arthroplasty Today, which is a publication of the American Association of Hip and Knee Surgeons. Today we’re going to talk about preventing hypothermia during total joint replacement surgery.  Dr McGrory recently conducted a pilot study at Maine Medical Center evaluating perioperative body temperature in patients undergoing total joint surgery.  All patients in the study received pre-operative warming at 41-degrees Celcius with 3M’s Bair Hugger forced air warmer and intraoperatively they received warm cotton blankets out of common blanket warmers and in-line IV fluid warming with 3M’s Ranger fluid warming device.  The patients in the study group were also draped in a reflective space blanket as the independent variable.  Dr McGrory will discuss the results of this pilot study in the podcast, some of which were published as a letter to the editor in The Journal of Arthroplasty, which I’ve linked to in the show notes.  And just to review:  perioperative hypothermia has been linked to numerous bad outcomes for patients including increased infection, delayed recovery, increased blood loss, disruptions in coagulation and cardiac events, not to mention, being cold is uncomfortable for the patient.  Perioperative temperature regulation is also linked to Medicare reimbursement with the goal of one temperature reading of at least 35.5C within 30 minutes immediately before or 15 minutes after the anesthesia stop time.  If hospitals meet this mark, they may see a slight increase in reimbursement and if they miss this mark, they may miss out on a substantial percentage of reimbursement.  So there is significant precedence for maintain perioperative normothermia.  During the podcast, we’re going to hint at the controversy with forced hot air warmers that’s been widely discussed in peer reviewed, as well as popular news, publications.  I want to roll through the conversation with Brian uninterrupted so you can hear how one surgeon has approached that controversy and still achieved normothermia for his patients intraoperatively, but at the end of the show, I’ll unpack & clarify the backstory on Bair Huggers so you know where that stands.  It’s a crazy story that twists through legal battles, medical literature, FDA statements and popular news media… so stay tuned to the end. References Carlson, J. (2018 December 8). Legal war engulfs 3M device.  StarTribune.  Retrieved from https://www.startribune.com/legal-war-engulfs-mmm-operating-room-device/502063131/?refresh=true.  Carlson, J. (2018 December 9). A closer look at the scientific evidence for and against 3M’s Bair Hugger.  StarTribune.  Retrieved from  https://www.startribune.com/a-closer-look-at-the-scientific-evidence-for-and-against-the-bair-hugger/502204321/  Carlson, J. (2019 August 1). Judge tosses lawsuits from 5,000-plus plaintiffs against 3M warming blanket. StarTribune.   Retrieved from https://www.startribune.com/judge-tosses-lawsuits-from-5-000-plus-plaintiffs-against-3m-warming-blanket/513491312/.  Kellam, M. D., Dieckmann, L. S., & Austin, P. N. (2013). Forced‐air warming devices and the risk of surgical site infections. AORN journal, 98(4), 353-369. Retrieved from https://aornjournal.onlinelibrary.wiley.com/doi/epdf/10.1016/j.aorn.2013.08.001  Madrid, E., Urrutia, G., i Figuls, M. R., Pardo‐Hernandez, H., Campos, J. M., Paniagua, P., … & Alonso‐Coello, P. (2016). Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults. Cochrane Database of Systematic Reviews, (4). https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD009016.pub2/epdf/full  Maisel, W., (2017 August 30).  Information about the Use of Forced Air Thermal Regulating Systems – Letter to Health Care Providers. U.S. Food & Drug Administration. https://www.fda.gov/medical-devices/letters-health-care-providers/information-about-use-forced-air-thermal-regulating-systems-letter-health-care-providers McGrory, B. (2018). Letter to the Editor on “Hypothermia in Total Joint Arthroplasty: A Wake-Up Call.” The Journal of Arthroplasty 33(4) 3056-3059.  Retrieved from: https://www.arthroplastyjournal.org/action/showPdf?pii=S0883-5403%2818%2930506-0  Meier, B. (2010 December 24).  Doctor Says a Device He Invented Poses Risks. The New York Times. Retrieved from https://www.nytimes.com/2010/12/25/business/25invent.html  Ralte, P., Mateu-Torres, F., Winton, J., Bardsley, J., Smith, M., Kent, M., … & Guisasola, I. (2020). Prevention of perioperative hypothermia: a prospective, randomized, controlled trial of Bair Hugger versus Inditherm in patients undergoing elective arthroscopic shoulder surgery. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 36(2), 347-352. Retrieved from https://doi.org/10.1016/j.arthro.2019.08.015  Simpson, J. B., Thomas, V. S., Ismaily, S. K., Muradov, P. I., Noble, P. C., & Incavo, S. J. (2018). Hypothermia in total joint arthroplasty: a wake-up call. The Journal of arthroplasty, 33(4), 1012-1018. Retrieved from https://www.arthroplastyjournal.org/article/S0883-5403(17)30969-5/fulltext  Turner, T. (2021 March 11). Bair Hugger Warming Blankets. Drugwatch.  Uggen, C. (2020).  Editorial Commentary: Just Getting Warmed Up: Risks, Benefits, and Economics of Active Warming Devices. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 36(2) Retrieved from https://www.arthroscopyjournal.org/action/showPdf?pii=S0749-8063%2819%2930843-6