Comparison of Passive Warming Effectiveness between Linen/Gel Pads vs. Opt-Shield for Patients Undergoing Robotic-Assisted Laparoscopic Prostatectomy/or Hysterectomy Brandon Giap MD, Miriam Bender PhD RN, Beverly Self MBA BSN RN, Ellen Schroeder BSN RN CNOR Introduction The OR environment may be considered by some to be an extreme environment due to its cold temperature. Patient warming to maintain normothermia has become a standard of care of the overall care of surgical patients to reduce complications attributed to preoperative hypothermia. However, maintaining normothermia can still be a challenge in certain clinical scenario such as surgeries in lithotomy positions (prostate, colon resections, and hysterectomy). Current practice standards include utilizing both active and passive means to prevent unintended preoperative hypothermia. New trends include The Opt-Shield™ LITHOTOMY, a double layer sheet fitted with buckles to secure the sheet to the operating room bed that has arm padding and a legging system that covers and insulates these extremities. The purpose of this study was to determine if the Opt-Shield provides superior passive warming than current standard practice of bed linens and gel pads. Methods This is an observational study using retrospective data. The sample included patients undergoing robotic-assisted prostatectomy or hysterectomy in Lithotomy position requiring a general anesthetic at Sharp Memorial Hospital from November 2013 to February Power analysis concluded a sample size of 30 patients for each group would be needed to detect a.3 degree Celsius difference in patient temperature at surgery end. Patient cohorts were those using linen/gel pad and Upper body Bair Hugger blanket and those with Opt-Shield LITHOTOMY and upper body Bair Hugger blanket. Patients were identified through the medical records by surgery type. Data was extracted from the anesthesia record, including type of warming, surgery duration, patient core temperatures and fluid administration. Results There were no significant demographic differences between groups (see Table 1). The prep and positioning time was 7 minutes less in the Opt-Shield group. There was no significant difference between groups at OR start, but a significant difference between cohorts at OR end, unadjusted (35.9 vs. 36.4, P<.01) (see Table 2). Within group comparison showed no difference in start and end temperatures for control group (35.9 to 35.9, p=.66) and a significant difference in Opt- Shield group (35.8 to 35.4, p<.001) (see Table 3). A repeated measure ANOVA that adjusted for surgery duration and fluid administration showed the same trend: Temperature before and after surgery was significantly different between cohorts (p=0.05). There was no significant interaction between temperature and time in surgery or fluids during surgery (see Table 4). There was a significant interaction between cohort grouping and temperature (P<.001): The Opt-Shield group had much higher post op temperatures than the control group. Conclusions There was a significant difference both between groups and within groups (for opt-shield) in pre and post- operative temperature. An adjusted model confirmed difference between cohorts. It also showed the Opt- shield group had significantly greater post temperatures than the control group. We concluded that the Opt-Shield can effectively complement active warming and result in significant heat gain in patients undergoing robotic-assisted prostatectomy/hysterectomy in lithotomy position. Table 1: Patient demographicsTable 2: OR data between groups Table 3: OR temperature data within group unadjusted Table 4: Repeated measure ANOVA, adjusted for surgery time and fluids administered Figure 1 : Body temperature pre and post-OR by group which showed significant temperature rise in Opt-Shield group Patient arms with traditional linens/gel pads (poorly insulated) Patient arms with Opt-Shield (well- insulated) Patient legs with Opt- Shield (well- covered) Patient legs with traditional linens/gel pads (exposed to cold air)