Optimizing Perioperative Temperature Management: The Case for Warm Irrigation in Orthopedics
Main Article Content
Abstract
Background: Surgical procedures, particularly in orthopedics, carry the risk of intraoperative hypothermia, which is associated with increased complications such as infection, bleeding, and prolonged recovery. Maintaining normothermia using warmed irrigation solutions and intravenous fluids has demonstrated significant benefits, including reduced postoperative pain and infection rates and shorter hospital stays. This manuscript reviews the current evidence supporting the use of warm saline solutions to improve perioperative patient conditions.
Methods: A literature search was conducted using PubMed, Embase, and Google Scholar.
Results: Analysis of available studies suggests that warmed irrigation effectively reduces the incidence of hypothermia and may decrease surgical site infection rates and postoperative shivering in patients undergoing orthopedic surgery.
Conclusion: Warm irrigation is a simple, cost-effective strategy for improving temperature management and enhancing patient outcomes during orthopedic surgery.
Article Details
How to Cite
SEIDEL, Daniela; PARODI, Dante.
Optimizing Perioperative Temperature Management: The Case for Warm Irrigation in Orthopedics.
Medical Research Archives, [S.l.], v. 13, n. 8, aug. 2025.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/6707>. Date accessed: 06 dec. 2025.
doi: https://doi.org/10.18103/mra.v13i8.6707.
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
1. Hart SR, Bordes B, Hart J, Corsino D, Harmon D. Unintended perioperative hypothermia. Ochsner J. 2011;11(3):259-270.
2. Ruetzler K, Kurz A. Consequences of perioperative hypothermia. In: Handbook of Clinical Neurology. Vol 157. Elsevier; 2018:687-697. doi:10.1016/B978-0-444-64074-1.00041-0
3. Mohamed MA, Abdelwahab Abdelkarim WA, Salih Aabdeen MA, et al. Evidence-based clinical practice guidelines for the management of perioperative hypothermia: Systematic review, critical appraisal, and quality assessment with the AGREE II instrument. Annals of Medicine & Surgery. 2022;79. doi:10.1016/j.amsu.2022.103887
4. Sessler DI. Mild perioperative hypothermia. N Engl J Med. 1997;336(24):1730-1737. doi:10.1056/NEJM199706123362407
5. Díaz M, Becker DE. Thermoregulation: physiological and clinical considerations during sedation and general anesthesia. Anesth Prog. 2010;57(1):25-34. doi:10.2344/0003-3006-57.1.25
6. Xu R, Hu X, Sun Z, Zhu X, Tang Y. Incidence of postoperative hypothermia and shivering and risk factors in patients undergoing malignant tumor surgery: a retrospective study. BMC Anesthesiol. 2023;23(1):31. doi:10.1186/s12871-023-01991-8
7. Moola S, Lockwood C. Effectiveness of strategies for the management and/or prevention of hypothermia within the adult perioperative environment. International Journal of Evidence-Based Healthcare. 2011;9(4):337-345. doi:10.1111/j.1744-1609.201 1.00227.x
8. Kelly JA, Doughty JK, Hasselbeck AN, Vacchiano CA. The effect of arthroscopic irrigation fluid warming on body temperature. J Perianesth Nurs. 2000;15(4):245-252. doi:10.1053/jpan.2000.9463
9. Hernandez M, Cutter TW, Apfelbaum JL. Hypothermia and Hyperthermia in the Ambulatory Surgical Patient. Clinics in Plastic Surgery. 2013;40(3):429-438. doi:10.1016/j.cps.2013.04.015
10. Leslie K, Bjorksten AR, Ugoni A, Mitchell P. Mild core hypothermia and anesthetic requirement for loss of responsiveness during propofol anesthesia for craniotomy. Anesth Analg. 2002;94(5). doi:10.1097/00000539-200205000-00045
11. Fritz HG, Holzmayr M, Walter B, Moeritz KU, Lupp A, Bauer R. The effect of mild hypothermia on plasma fentanyl concentration and biotransformation in juvenile pigs. Anesth Analg. 2005;100(4):996-1002. doi:10.1213/01.ANE.0000146517.17910.54
12. Rajagopalan S, Mascha E, Na J, Sessler DI. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology. 2008;108(1) :71-77. doi:10.1097/01.anes.0000296719.73450.52
13. Reynolds L, Beckmann J, Kurz A. Perioperative complications of hypothermia. Best Pract Res Clin Anaesthesiol. 2008;22(4):645-657. doi:10.1016/j.bpa.2008.07.005
14. Sessler DI, Warner DS, Warner MA. Temperature Monitoring and Perioperative Thermoregulation. Anesthesiology. 2008;109(2):318-338. doi:10.1097/ALN.0b013e31817f6d76
15. Camus Y, Lienhart A, Cohen S, Delva E. The effects of warming intravenous fluids on intraoperative hypothermia and postoperative shivering during prolonged abdominal surgery. Acta Anaesthesiologica Scandinavica. 1996;40(7):779-782. doi:10.1111/j.1399-6576.1996.tb04532.x
16. Campbell G, Alderson P, Smith AF, Warttig S. Warming of intravenous and irrigation fluids for preventing inadvertent perioperative hypothermia. Cochrane Anaesthesia Group, ed. Cochrane Database of Systematic Reviews. 2015;2015(4). doi:10.1002/14651858.CD009891.pub2
17. Steelman VM, Chae S, Duff J, Anderson MJ, Zaidi A. Warming of Irrigation Fluids for Prevention of Perioperative Hypothermia During Arthroscopy: A Systematic Review and Meta-analysis. Arthroscopy. 2018;34(3):930-942.e2. doi:10.1016/j.arthro.2017.09.024
18. Park SR, Yoon YH, Kim NH, et al. Effect of saline irrigation temperature difference on postoperative acute pain and hypothermia during biportal endoscopic spine surgery. Eur Spine J. 2024;33(11):4378-4384. doi:10.1007/s00586-024-08322-6
19. Hasankhani H, Mohammadi E, Moazzami F, Mokhtari M, Naghgizadh MM. The effects of intravenous fluids temperature on perioperative hemodynamic situation, post-operative shivering, and recovery in orthopaedic surgery. Can Oper Room Nurs J. 2007;25(1):20-27.
20. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med. 1996;334(19):1209-1215. doi:10.1056/NEJM199605093341901
21. Liedl HJC, Lazenby KA, Arimoto RS, Singh A, Strelzow JA. Normothermia to Decrease Surgical Site Infection Risk: Silver Bullet or Fool’s Gold? A Retrospective Cohort Study. JAAOS Glob Res Rev. 2024;8(6). doi:10.5435/JAAOSGlobal-D-23-00227
22. Sessler DI. Perioperative thermoregulation and heat balance. Lancet. 2016;387(10038):2655-2664. doi:10.1016/S0140-6736(15)00981-2
23. Madrid E, Urrútia G, Roqué I Figuls M, et al. Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults. Cochrane Anaesthesia Group, ed. Cochrane Database of Systematic Reviews. 2016;2016(4). doi:10.1002/14651858.CD009016.pub2
24. Simegn GD, Bayable SD, Fetene MB. Prevention and management of perioperative hypothermia in adult elective surgical patients: A systematic review. Annals of Medicine and Surgery. 2021;72:103059. doi:10.1016/j.amsu.2021.103059
25. Parodi D, Valderrama J, Tobar C, et al. Effect of Warmed Irrigation Solution on Core Body Temperature During Hip Arthroscopy for Femoroacetabular Impingement. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2014;30(1):36-41. doi:10.1016/j.arthro.2013.08.035
26. Parodi D, Tobar C, Valderrama J, et al. Hip Arthroscopy and Hypothermia. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2012;28(7):924-928. doi:10.1016/j.arthro.2011.12.012
27. Kelly JA, Doughty JK, Hasselbeck AN, Vacchiano CA. The effect of arthroscopic irrigation fluid warming on body temperature. J Perianesth Nurs. 2000;15(4):245-252. doi:10.1053/jpan.2000.9463
28. Steelman VM, Chae S, Duff J, Anderson MJ, Zaidi A. Warming of Irrigation Fluids for Prevention of Perioperative Hypothermia During Arthroscopy: A Systematic Review and Meta-analysis. Arthroscopy. 2018;34(3):930-942.e2. doi:10.1016/j.arthro.2017.09.024
29. Fırat A, Veizi E, Kalaycı İ, et al. Heated Irrigation Fluids Did Not Reduce the Prevalence of Rectally Measured Hypothermia During Hip Arthroscopic Surgery Compared With Room-Temperature Fluids: A Prospective Randomized Trial. Orthopaedic Journal of Sports Medicine. 2025;13(6):23259671251350401. doi:10.1177/23259671251350401
30. Sardana V, Burzynski J, Scuderi GR. The influence of the irrigating solution on articular cartilage in arthroscopic surgery: A systematic review. Journal of Orthopaedics. 2019;16(2):158-165. doi:https://doi.org/10.1016/j.jor.2019.02.018
2. Ruetzler K, Kurz A. Consequences of perioperative hypothermia. In: Handbook of Clinical Neurology. Vol 157. Elsevier; 2018:687-697. doi:10.1016/B978-0-444-64074-1.00041-0
3. Mohamed MA, Abdelwahab Abdelkarim WA, Salih Aabdeen MA, et al. Evidence-based clinical practice guidelines for the management of perioperative hypothermia: Systematic review, critical appraisal, and quality assessment with the AGREE II instrument. Annals of Medicine & Surgery. 2022;79. doi:10.1016/j.amsu.2022.103887
4. Sessler DI. Mild perioperative hypothermia. N Engl J Med. 1997;336(24):1730-1737. doi:10.1056/NEJM199706123362407
5. Díaz M, Becker DE. Thermoregulation: physiological and clinical considerations during sedation and general anesthesia. Anesth Prog. 2010;57(1):25-34. doi:10.2344/0003-3006-57.1.25
6. Xu R, Hu X, Sun Z, Zhu X, Tang Y. Incidence of postoperative hypothermia and shivering and risk factors in patients undergoing malignant tumor surgery: a retrospective study. BMC Anesthesiol. 2023;23(1):31. doi:10.1186/s12871-023-01991-8
7. Moola S, Lockwood C. Effectiveness of strategies for the management and/or prevention of hypothermia within the adult perioperative environment. International Journal of Evidence-Based Healthcare. 2011;9(4):337-345. doi:10.1111/j.1744-1609.201 1.00227.x
8. Kelly JA, Doughty JK, Hasselbeck AN, Vacchiano CA. The effect of arthroscopic irrigation fluid warming on body temperature. J Perianesth Nurs. 2000;15(4):245-252. doi:10.1053/jpan.2000.9463
9. Hernandez M, Cutter TW, Apfelbaum JL. Hypothermia and Hyperthermia in the Ambulatory Surgical Patient. Clinics in Plastic Surgery. 2013;40(3):429-438. doi:10.1016/j.cps.2013.04.015
10. Leslie K, Bjorksten AR, Ugoni A, Mitchell P. Mild core hypothermia and anesthetic requirement for loss of responsiveness during propofol anesthesia for craniotomy. Anesth Analg. 2002;94(5). doi:10.1097/00000539-200205000-00045
11. Fritz HG, Holzmayr M, Walter B, Moeritz KU, Lupp A, Bauer R. The effect of mild hypothermia on plasma fentanyl concentration and biotransformation in juvenile pigs. Anesth Analg. 2005;100(4):996-1002. doi:10.1213/01.ANE.0000146517.17910.54
12. Rajagopalan S, Mascha E, Na J, Sessler DI. The effects of mild perioperative hypothermia on blood loss and transfusion requirement. Anesthesiology. 2008;108(1) :71-77. doi:10.1097/01.anes.0000296719.73450.52
13. Reynolds L, Beckmann J, Kurz A. Perioperative complications of hypothermia. Best Pract Res Clin Anaesthesiol. 2008;22(4):645-657. doi:10.1016/j.bpa.2008.07.005
14. Sessler DI, Warner DS, Warner MA. Temperature Monitoring and Perioperative Thermoregulation. Anesthesiology. 2008;109(2):318-338. doi:10.1097/ALN.0b013e31817f6d76
15. Camus Y, Lienhart A, Cohen S, Delva E. The effects of warming intravenous fluids on intraoperative hypothermia and postoperative shivering during prolonged abdominal surgery. Acta Anaesthesiologica Scandinavica. 1996;40(7):779-782. doi:10.1111/j.1399-6576.1996.tb04532.x
16. Campbell G, Alderson P, Smith AF, Warttig S. Warming of intravenous and irrigation fluids for preventing inadvertent perioperative hypothermia. Cochrane Anaesthesia Group, ed. Cochrane Database of Systematic Reviews. 2015;2015(4). doi:10.1002/14651858.CD009891.pub2
17. Steelman VM, Chae S, Duff J, Anderson MJ, Zaidi A. Warming of Irrigation Fluids for Prevention of Perioperative Hypothermia During Arthroscopy: A Systematic Review and Meta-analysis. Arthroscopy. 2018;34(3):930-942.e2. doi:10.1016/j.arthro.2017.09.024
18. Park SR, Yoon YH, Kim NH, et al. Effect of saline irrigation temperature difference on postoperative acute pain and hypothermia during biportal endoscopic spine surgery. Eur Spine J. 2024;33(11):4378-4384. doi:10.1007/s00586-024-08322-6
19. Hasankhani H, Mohammadi E, Moazzami F, Mokhtari M, Naghgizadh MM. The effects of intravenous fluids temperature on perioperative hemodynamic situation, post-operative shivering, and recovery in orthopaedic surgery. Can Oper Room Nurs J. 2007;25(1):20-27.
20. Kurz A, Sessler DI, Lenhardt R. Perioperative normothermia to reduce the incidence of surgical-wound infection and shorten hospitalization. Study of Wound Infection and Temperature Group. N Engl J Med. 1996;334(19):1209-1215. doi:10.1056/NEJM199605093341901
21. Liedl HJC, Lazenby KA, Arimoto RS, Singh A, Strelzow JA. Normothermia to Decrease Surgical Site Infection Risk: Silver Bullet or Fool’s Gold? A Retrospective Cohort Study. JAAOS Glob Res Rev. 2024;8(6). doi:10.5435/JAAOSGlobal-D-23-00227
22. Sessler DI. Perioperative thermoregulation and heat balance. Lancet. 2016;387(10038):2655-2664. doi:10.1016/S0140-6736(15)00981-2
23. Madrid E, Urrútia G, Roqué I Figuls M, et al. Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults. Cochrane Anaesthesia Group, ed. Cochrane Database of Systematic Reviews. 2016;2016(4). doi:10.1002/14651858.CD009016.pub2
24. Simegn GD, Bayable SD, Fetene MB. Prevention and management of perioperative hypothermia in adult elective surgical patients: A systematic review. Annals of Medicine and Surgery. 2021;72:103059. doi:10.1016/j.amsu.2021.103059
25. Parodi D, Valderrama J, Tobar C, et al. Effect of Warmed Irrigation Solution on Core Body Temperature During Hip Arthroscopy for Femoroacetabular Impingement. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2014;30(1):36-41. doi:10.1016/j.arthro.2013.08.035
26. Parodi D, Tobar C, Valderrama J, et al. Hip Arthroscopy and Hypothermia. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2012;28(7):924-928. doi:10.1016/j.arthro.2011.12.012
27. Kelly JA, Doughty JK, Hasselbeck AN, Vacchiano CA. The effect of arthroscopic irrigation fluid warming on body temperature. J Perianesth Nurs. 2000;15(4):245-252. doi:10.1053/jpan.2000.9463
28. Steelman VM, Chae S, Duff J, Anderson MJ, Zaidi A. Warming of Irrigation Fluids for Prevention of Perioperative Hypothermia During Arthroscopy: A Systematic Review and Meta-analysis. Arthroscopy. 2018;34(3):930-942.e2. doi:10.1016/j.arthro.2017.09.024
29. Fırat A, Veizi E, Kalaycı İ, et al. Heated Irrigation Fluids Did Not Reduce the Prevalence of Rectally Measured Hypothermia During Hip Arthroscopic Surgery Compared With Room-Temperature Fluids: A Prospective Randomized Trial. Orthopaedic Journal of Sports Medicine. 2025;13(6):23259671251350401. doi:10.1177/23259671251350401
30. Sardana V, Burzynski J, Scuderi GR. The influence of the irrigating solution on articular cartilage in arthroscopic surgery: A systematic review. Journal of Orthopaedics. 2019;16(2):158-165. doi:https://doi.org/10.1016/j.jor.2019.02.018