Ambient Temperatures in the Burn Operating Room

To the Editor, Patients with major burn injuries are particularly susceptible to hypothermia (core temperatures below 36 °C) due to the disruption of their epidermal barrier.1,2 Cool ambient temperatures increase the metabolic rate and resting energy expenditure, diverting resources away from wound healing.Furthermore, perioperative hypothermia, specifically, has been shown to predispose to both infectious and non-infectious complications, including myocardial infarction, thromboembolic events, surgical site infections, and bleeding.[1][2][3][4] Surveys suggest that one of the most important strategies to reduce perioperative hypothermia is to increase ambient temperatures in the operating room.3,5 As part of a quality improvement (QI) initiative, we sought to document these temperatures at an American Burn Association-verified burn centre, and establish the relationship, if any, between operating room ambient temperatures, operative duration, and our patients' core temperatures at the conclusion of surgery.We measured operating room temperatures for a one year period between March 1, 2020 and February 28, 2021, using a wall-mounted, smart sensor (Sensor Push TM , Garrison, New York, USA).This calibrated device collected temperatures at 1-min intervals and was synchronized via Bluetooth to an encrypted mobile smart phone using the Sensor Push TM application, and then transferred the data to Microsoft Excel TM for analysis.All acute burn surgeries over 2 h in duration were included in this QI study.Core patient temperatures are routinely measured at the end of surgery using a nasopharyngeal thermometer, and are recorded in a performance improvement database.During the period of study, 119 patients underwent 261 acute burn surgeries longer than 2 h by 4 burn surgeons (mean 2.19 procedures per patient, range 1-15).The mean age of the patients was 49.82 years (range 18-82), the mean total body surface area (TBSA) burn was 15.82 (range 1%-62%), and most were male (n = 86, 72.3%).The mean operative duration was 211 min (range 120-468).Eight patients died (6.7%, mean age 65 years).