Hypothermia can trigger thermoregulatory vasoconstriction, which decreases tissue oxygen tension. It directly impairs immune response and decreases the strength of healing wounds. The chemotaxis and phagocytosis of granulocytes are impaired, as well as the motility of macrophages and oxidative killing by neutrophils. Scarring and the formation of collagen strands are seen in healing wounds, and these functions depend on oxygen tissue tension.
Measures such as forced air-warming and fluid warming to maintain normothermia during surgery can help reduce blood loss and improve healing, resulting in a shortened hospitalization.
Warming devices are suggested for use in the operating room and during thev surgical procedure with a moderate strength of recommendation. These devices can be unavailable in low-resource stings and they have an additional cost; however, simple blankets might be as efficient as electrical devices for this purpose.
Hyperglycemia is associated with an increased risk of SSI.
A more aggressive approach to glycemic control in the perioperative period results in better wound healing, lower morbidity and shorter hospital stays. Protocols are suggested for intensive perioperative blood glucose control for both diabetic and nondiabetic patients, even though the strength of recommendation is low. Medical staff training is required.