INTRODUCTION
Laparoscopic surgery has become important in modern medicine, especially in the treatment of colorectal cancer[1-3]. Its minimally invasive and efficient characteristics have benefited many patients. However, with the increasing aging population, older patients have gradually become the main group undergoing laparoscopic surgery[4]. Due to the decline in physical function and increased sensitivity to external stimuli, perioperative management and care are particularly important for this group of patients undergoing laparoscopic colorectal cancer surgery[5-7]. This study investigated perioperative hypothermia in older patients undergoing laparoscopic colorectal cancer surgery, as well as the construction and application of composite insulation nursing interventions. We aimed to provide a reference for improving the surgical safety and postoperative recovery of older patients. The perioperative period for older patients undergoing laparoscopic colorectal cancer surgery is a complex and critical process, involving multiple stages such as preoperative preparation, surgical procedures, and postoperative rehabilitation[8,9]. During this period, older patients face various challenges, and one of the most important issues is perioperative hypothermia and related complications. Low body temperature affects the surgical outcome of patients and increases their postoperative risk, such as cardiovascular events, and infections, further prolonging their hospital stay and reducing their quality of life. Therefore, how to effectively prevent and respond to perioperative hypothermia and its related complications has become one of the keys aims of perioperative management of older patients undergoing laparoscopic colorectal cancer surgery.
Perioperative hypothermia refers to the body temperature falling below the normal range (usually < 36 °C) during surgery or postoperative recovery[10]. In older patients undergoing laparoscopic colorectal cancer surgery, the incidence of hypothermia is high, which is mainly related to the following factors. As people age, the central function of temperature regulation gradually decreases, and their ability to adapt to changes in the external environment weakens, and they are prone to hypothermia. Both general and regional anesthesia can inhibit the function of the temperature regulatory center, leading to a decrease in body temperature. During surgery, patients are exposed to a lower temperature environment, coupled with tissue damage and bleeding caused by the operation, resulting in increased heat dissipation and decreased body temperature. Some drugs used during surgery, such as antibiotics and analgesics, may also affect temperature regulation[11-14].
The impact of hypothermia on older patients postoperatively is multifaceted. Firstly, hypothermia can have a profound effect on surgical outcomes. For instance, it can lead to increased bleeding and prolonged operating time, which in turn reduces the success rate. This is especially concerning in older patients due to their often reduced physiological reserves and comorbidities, making them more susceptible to the adverse effects of hypothermia. Secondly, hypothermia significantly increases the postoperative risks for older patients. Cardiovascular events such as arrhythmia and myocardial infarction are more likely to occur. These events may be exacerbated in older patients due to decreased myocardial contractility and the induction of arrhythmias caused by hypothermia. Thirdly, the risk of postoperative infection is heightened in older patients due to hypothermia-related decreases in immune function and delayed wound healing. The immune system in older people is already compromised, and hypothermia further weakens it, making them more prone to infections[15]. Hypothermia can lead to a prolonged length of hospital stay for older patients, which not only increases medical expenses but also significantly lowers their quality of life. The extended hospitalization can be attributed to the need for additional monitoring and treatment of complications arising from hypothermia, such as infections and cardiovascular issues. In summary, the clinical hazards of postoperative hypothermia in older patients are substantial, affecting their immediate surgical outcomes and their long-term recovery and quality of life. It is crucial to implement effective measures to prevent and manage hypothermia in this vulnerable patient population to mitigate these risks[16].
In response to the issue of perioperative hypothermia in older patients undergoing laparoscopic colorectal cancer surgery, composite insulation nursing intervention has gradually become a new trend in perioperative insulation[17]. Composite insulation nursing intervention refers to the comprehensive use of multiple methods on the basis of traditional insulation measures to more effectively maintain body temperature and reduce hypothermia and related complications. In the preoperative preparation stage, in addition to routine preoperative evaluation and preparation, special attention should be paid to the central function of temperature regulation. For patients with temperature regulation disorders, intervention measures should be taken in advance, such as adjusting indoor temperature and adding warm clothing. At the same time, medical staff should also provide detailed explanations of the surgical process and possible situations to patients and their families, eliminate the patient’s nervousness, and reduce temperature regulation abnormalities caused by anxiety. During surgery, in addition to maintaining appropriate temperature and humidity in the operating room, the following measures can also be taken to reduce patient heat loss and maintain patient body temperature. Insulation blanket preheating: Before entering the operating room, the inflatable insulation blanket is used to preheat the patient to increase their body temperature. The temperature of the inflatable insulation blanket should be adjusted according to the actual situation of the patient to avoid being too high or too low. Self-made warming and warming head cover: during surgery, the patient’s head is exposed to the air, making it easy to dissipate heat. Therefore, a homemade warming headband can be made to cover the patient’s head to reduce the loss of head heat. The material of the headband should be soft, warm, and breathable to ensure patient comfort and safety. Infusion heating: during surgery, a large amount of liquid needs to be injected, which is usually cold. Therefore, an infusion heater can be used to heat the liquid, making it close to body temperature before entering the body. Using insulation blankets or pads: During surgery, insulation blankets or pads can be used to cover the patient’s body to reduce heat loss. These insulation devices should have good insulation performance without causing compression or discomfort to patients. In the postoperative rehabilitation stage, in addition to continuing to take the above insulation measures, it is also necessary to strengthen the patient’s nutritional support and psychological counseling. Nutritional support is an important part of postoperative recovery, and personalized dietary plans should be developed based on the patient’s actual situation to ensure that they receive sufficient nutritional support. At the same time, medical staff should also pay attention to the psychological status of patients, provide timely psychological counseling and comfort, help patients alleviate negative emotions such as anxiety and depression, and promote their recovery.
MATERIALS AND METHODS
Patient enrollment
We enrolled 100 older patients who underwent laparoscopic surgery for colorectal cancer at Huzhou Central Hospital between September 2023 and April 2024. Patients were randomly assigned to a conventional insulation care group (n = 50) or a composite insulation care intervention group (n = 50) using a double-blind design. Randomization was performed using a random number table method, and the allocation sequence was concealed from both patients and healthcare providers until the intervention was implemented. The conventional group comprised 50.7% males and 49.3% females, with an age range of 65-85 years and a mean age of 71.62 ± 4.39 years. The intervention group included 52% males and 48% females, with an age range of 67-86 years and a mean age of 70.32 ± 8.76 years. No significant differences were observed in baseline characteristics such as gender and age between the two groups (P > 0.05), ensuring comparability.
The study was approved by the Ethics Committee of Huzhou Central Hospital (No. 202209014-01) and conducted in accordance with the Declaration of Helsinki.
Inclusion and exclusion criteria
Inclusion criteria: Patients diagnosed with colorectal cancer eligible for laparoscopic surgery, receiving intravenous combined inhalation anesthesia, with a normal preoperative body temperature (defined as axillary temperature ≥ 36.5 °C), and who provided written informed consent.
Exclusion criteria: (1) Patients with severe illness or life-threatening conditions; (2) Those with significant organ dysfunction or coagulopathy (defined as an international normalized ratio > 1.5 or partial thromboplastin time > 40 seconds); (3) Patients with a history of central temperature dysregulation (defined as episodes of hypothermia or hyperthermia within the past 6 months); (4) Individuals with blood, immune, or central nervous system disorders; and (5) Those with cognitive impairment (defined as a mini-mental state examination score < 24), psychiatric illness, or related conditions.
Nursing methods
All patients underwent standard preoperative assessments, including vital sign examination, routine urinalysis, and complete blood count. Surgery was performed by the same professional team. Interventions in the two groups were as follows.
Conventional group: The operating room temperature was set at 25 °C preoperatively and 22 °C postoperatively, with a humidity level of 45%. Disinfectant, infusion, and irrigation solutions were warmed to 37 °C. Patients were covered with a cotton quilt for insulation during surgery.
Composite insulation group: In the composite insulation group, patients underwent a comprehensive warming protocol designed to maintain their body temperature throughout the surgical process. Preoperatively, patients were warmed with an inflatable heating blanket set at 40 °C for 30 minutes. This blanket uses forced-air technology to circulate warm air through a perforated surface, creating a warm air layer over the patient’s body to prevent heat loss. The operating room environment was carefully controlled, with the temperature set at 25 °C before surgery and adjusted to 22 °C after surgery, and the humidity maintained at 45%. A temperature-regulated blanket was placed on the operating table before surgery and preheated to 35 °C. All disinfectant, infusion, and irrigation solutions were heated to 37 °C before use. During surgery, an inflatable heating blanket covered the patient’s chest and abdomen for at least 20 minutes before anesthesia and remained in place throughout the procedure. Additionally, carbon dioxide gas was heated to 37 °C during laparoscopic surgery to prevent heat loss. Postoperatively, patients were rewarmed using an inflatable heating blanket set at 40 °C for 30 minutes during the recovery phase.
To maintain patient compliance with warming measures during lengthy surgeries, patients were educated on their importance and encouraged to voice any discomfort. They were positioned comfortably with pillows and supports to prevent pressure points, allowing warming devices to function effectively. Healthcare providers continuously monitored patient comfort and warming device placement, making necessary adjustments. Clear communication was maintained to address concerns and ensure cooperation, thereby sustaining both patient comfort and effective warming throughout the procedure.
Observation indicators
The primary outcomes measured were heart rate and systolic blood pressure immediately after surgery, and at 15 and 30 minutes postoperatively. Secondary outcomes included patient rewarming time, recovery time, and the incidence of postoperative complications. Hypothermia was defined as axillary temperature ≤ 36 °C.
Statistical analysis
Data were analyzed using SPSS 25.0 software. Quantitative data are presented as mean ± SD, with intergroup and intragroup comparisons made using t-tests and repeated measures analysis of variance. Numerical data are expressed as frequencies and percentages, with intergroup comparisons conducted using the χ² test. Statistical significance was set at P < 0.05. Data normality was assessed using the Shapiro-Wilk test. The results showed that all data were normally distributed (the Shapiro-Wilk test statistic for the primary outcome was W = 0.985, P = 0.234). Sensitivity analyses were performed using multiple imputation methods to handle missing data and robust regression models to confirm the stability of the results. The sensitivity analysis confirmed that the primary findings remained consistent across different analytical approaches.
DISCUSSION
Older patients undergoing laparoscopic colorectal cancer surgery often face a decline in their ability to regulate body temperature due to natural decline in physical function. The weakening of this ability to regulate body temperature is particularly significant during the perioperative period, which can easily lead to hypothermia[18-20]. Low body temperature has a negative impact on patient comfort, and more importantly, it may increase surgical risk, affect surgical outcomes, and increase the risk of postoperative complications such as cardiovascular events, and infection[21,22]. Therefore, for older patients undergoing laparoscopic colorectal cancer surgery, it is important to take effective insulation measures to maintain their body temperature stability. Composite insulation scheme, as a comprehensive temperature management measure, has been widely used in perioperative management of older patients in recent years. This aims to provide patients with comprehensive insulation support by integrating various insulation methods, such as preheating with inflatable insulation blankets and self-made rewarming headbands, effectively reducing heat loss and maintaining stable body temperature[23-25].
Firstly, preheating of inflatable insulation blankets is an important part of composite insulation schemes. Before the patient enters the operating room, using an insulation blanket to preheat the operating table can significantly increase initial body temperature, laying a good foundation for stabilizing temperature during surgery. The preheating temperature and timing of the insulation blanket should be adjusted according to the specific situation of the patient to ensure its safety and effectiveness. Secondly, homemade warming headbands are also an important component of composite insulation schemes. Due to the weaker ability of older patients to regulate body temperature, the head often becomes an important area for heat loss. A homemade warming headband can effectively reduce the loss of heat through the head, thereby maintaining stability of the patient’s body temperature. The material used for making the headbands should be soft, comfortable, and have good breathability to ensure patient comfort. In addition to the two insulation measures mentioned above, the composite insulation scheme also includes various other means, such as covering with insulation blankets during surgery, and controlling the temperature and humidity inside the operating room. These measures work together to form a comprehensive insulation system for patients, providing effective temperature protection.
The results of this study showed that the intervention group using a composite insulation scheme outperformed the conventional group in postoperative heart rate, systolic blood pressure, and rewarming time. This result indicates that the composite insulation scheme can more effectively maintain the patient’s body temperature, reduce heat loss, and thus reduce the incidence of hypothermia and related complications. The enhanced effectiveness of the composite insulation scheme compared to traditional measures may be attributed to its multifaceted physiological impacts. For instance, it could optimize blood hemodynamics by maintaining a more stable core body temperature, thereby ensuring adequate blood flow to vital organs and tissues. Additionally, it might modulate the inflammatory response, as stable body temperature is crucial for the proper functioning of the immune system, potentially reducing the severity of postoperative inflammation and associated complications. Meanwhile, the postoperative stress response of the intervention group patients was also relatively mild, and the safety and quality of postoperative recovery were significantly improved. However, when implementing a composite insulation scheme, we also need to pay attention to the following nursing points. Firstly, a comprehensive evaluation of the patient’s temperature regulation ability should be conducted before surgery. For patients with temperature regulation disorders, such as advanced age, malnutrition, chronic diseases, etc., intervention measures should be taken in advance, such as increasing the preheating time of insulation blankets, and adjusting the material and size of warming headbands. This can ensure that patients receive more effective insulation support during surgery. Secondly, during surgery, it is important to ensure that the temperature and humidity in the operating room are appropriate[26-29]. The temperature in the operating room, whether too low or too high, may affect the patient’s ability to regulate body temperature, leading to adverse reactions such as hypothermia or hyperthermia. At the same time, the humidity in the operating room should also be controlled within an appropriate range to avoid discomfort for patients due to dry skin. In addition, measures such as preheating the electric blanket and homemade warming headbands should be adjusted according to the actual situation of the patient. The temperature regulation ability and comfort perception of different patients may vary, so when using these insulation measures, adjustments should be made according to the specific situation of the patient to ensure their safety and effectiveness. At the same time, nurses should also closely monitor changes in the patient’s body temperature, and promptly detect and handle abnormal conditions such as hypothermia. Finally, close observation of the patient’s temperature changes should continue after surgery. Postoperative patients may experience temperature fluctuations due to factors such as surgical trauma and residual anesthetic drugs. Therefore, nurses should regularly monitor the patient’s temperature and take appropriate insulation measures as needed. At the same time, nurses should also strengthen psychological support and counseling for patients, help them establish confidence in overcoming the disease, and promote postoperative recovery[30-32]. It is also worth noting that our findings align with and extend upon the existing body of literature, for example, which also explored the benefits of advanced thermal management strategies in surgical settings, further substantiating the clinical significance and innovation of our composite insulation scheme.
With the continuous advancement of medical technology and the updating of nursing concepts, the application of composite insulation schemes in perioperative management of older patients will become increasingly widespread. In the future, we can further explore the effects of composite insulation schemes in more types of surgical patients, as well as their combined application with other nursing measures. For example, a composite insulation scheme can be combined with measures such as pain management and nutritional support to form a more comprehensive perioperative management system, providing patients with more comprehensive and meticulous nursing services. We can further optimize the implementation details and nursing points of the composite insulation scheme by conducting in-depth research on the physiological characteristics and pathological changes of patients. For example, personalized insulation plans can be developed based on factors such as the patient’s temperature regulation ability and surgical site. The clinical application value of composite insulation schemes can be further enhanced by improving insulation materials and enhancing insulation effects[33-35]. With the development of intelligent and precise medical technology, composite insulation solutions will also move towards a more intelligent and precise direction. This project adopts the wireless body temperature sensor iThermonitor®[36] and the thermal insulation blanket linkage, real-time monitoring of patient body temperature changes can be achieved, and insulation measures can be automatically adjusted as needed[37-39]. The clinical effectiveness of composite insulation schemes can be more accurately evaluated and optimized through technical means such as big data analysis. These intelligent and precise applications will provide more powerful guarantees for the surgical safety and postoperative recovery quality of older patients[40,41].
In summary, the composite insulation scheme has significant clinical effects in the perioperative period of older patients undergoing laparoscopic colorectal cancer surgery. By integrating multiple insulation methods, this plan can effectively maintain patient temperature stability, reduce heat loss, and lower the incidence of hypothermia and related complications. In the implementation process, we need to pay attention to nursing points to ensure the comfort and safety of patients. In the future, with the continuous progress of medical technology and the updating of nursing concepts, the application of composite insulation schemes will be more widespread, providing more powerful guarantees for the surgical safety and postoperative recovery quality of older patients.
This study had some limitations. Firstly, the limited sample size may affect the generality and reliability of the results. Although there were 100 participants, we did not perform a power analysis to determine if this sample size was sufficient to support the conclusions. We acknowledge this as a potential limitation and suggest it as a direction for future research. Secondly, the study was conducted in only one hospital, so the sample may lack representativeness. Thirdly, although this study focused on older patients undergoing laparoscopic colorectal cancer surgery, it is unclear whether the results are applicable to other types of cancer patients. Lastly, this study may not have considered other potential confounding factors, such as patients' baseline body temperature and surgical duration, which may also have an impact on the results. In addition, although standardized measurement protocols were used to reduce bias, there may still be observer bias. We suggest that in future research, different researchers could be involved in measuring body temperature and other physiological indicators.
