Effect Of Multimodal Warming Regimen On Postoperative Outcomes And Cost-effectiveness In Patients Undergoing Resection Of Liver Cancer

ObjectiveTo evaluate the effect of multimodal warming regimen on the postoperative outcomes and cost-effectiveness in the patients undergoing resection of liver cancer.MethodsSixty American Society of Anesthesiologists physical status?or?patients of both sexes,aged<35-64 yrs,with body mass index of 28-24 kg/m²,of liver function Child-Pugh grade A,scheduled for elective resection of liver cancer,were divided into2 groups?n=30 each?using a random number table:routine warming group?group R?and multimodal warming group?group M?.Quilts were covered on the body exposed before induction of anesthesia,and the abdominal cavity was washed with the room-temperature peritoneal lavage fluid during operation in group R.In group M,the lower body was covered using the forced-air warming system at 30 min before induction of anesthesia,and the temperature was maintained at 38?until the end of operation;the solution used for infusion was warmed to 42?using a fluid-warming device during operation;the abdominal cavity was washed with 0.9%sodium chloride injection which was preheat to 37?during operation.The rectal temperature was recorded after anesthesia induction and before tracheal intubation?T₁?,at 30?T₂?,60?T₃?,90?T₄?,120?T₅?and 150 min after anesthesia?T₆?and at the end of operation?T₇?.The parameters of thrombelastogram were measured before induction of anesthesia?T₀?,at T₇ and at 12 h after operation?T₈?.At T₀,T₇,T₈ and 24 and 48 h after operation(T_9-10),blood samples were taken from the internal jugular vein for determination of plasma interleukin-6 concentrations by enzyme-linked immunosorbent assay.The extubation time,duration of PACU stay,intraoperative blood loss,intraoperative blood transfusion,requirement for allogeneic blood transfusion,length of hospitalization,occurrence of postoperative shivering,occurrence of hypothermia,volume of drainage on 1st and 3rd days after operation,neutrophil count,cost of general anesthesia and total cost of hospitalization were recorded.Results:1.Gender,age,height,weight,anesthesia time,operation time and the amount of urine volume and infusion among the two groups had no significant difference?P>0.05?.2.Compared with T1,the body temperature was decreased at T2-7 in group C and T_4-7 in group R?P<0.05?;Compared with group C,the body temperature was increased at T_2-7-7 in group R?P<0.05?.3.Compared with group C,the extubation time and duration of PACU stay were significantly shortened,the intraoperative blood loss,intraoperative volume of blood transfused,volume of drainage on 1st day after operation and hospitalization days were reduced,the requirement for allogeneic blood transfusion and incidence of postoperative shivering and hypothermia were decreased in group R?P<0.05?.4.There was no significant difference in R,K and?angle at T0 and T8 between both group?P>0.05?;R and K were shortened at T7,?angle was enlarged at T₇?P<0.05?.5.There was no significant difference in the concentration of interleukin-6 and the neutrophil count on the 3st day after operation at T₀,T₇?T₁₀0 between both group?P>0.05?;Compared with T0,the concentration of interleukin-6 at T7-10 were increased in group C and group R.Compared with group C,the concentration of interleukin-6 at T₈ and T₉,the neutrophil count on the 1st day after operation was reduced in group R?P<0.05?.6.Compared with group C,the cost of anesthesia was increased,and the total cost of hospitalization was reduced in group R?P<0.05?.Conclusion:Multimodal warming regimen can reduce the incidence of hypothermia,reduce the occurrence of adverse complications,improve the patient's coagulation function,reduce the inflammatory response and improve the prognosis.In terms of cost,the total hospital expenses has been reduced,even though the cost of anesthesia has increased.