Value of Active Warming Devices for Intraoperative Hypothermia Prevention-A Meta-Analysis and Cost-Benefit Analysis.

PURPOSE: Historically, studies suggested that intraoperative hypothermia (IH) could result in significant resource consumption, but more recent studies have found the opposite. The purpose of this study is to estimate the value of active warming devices for IH prevention based on synthesized evidence. METHODS: A cost-benefit analysis was conducted using the effect of active warming versus passive warming devices for intraoperative hypothermia from a meta-analysis. The item-based aggregated treatment cost approach was adopted to estimate the cost of each adverse event, which was then weighted to calculate the total cost of IH. RESULTS: IH was associated with higher risks of bleeding, surgical site infection, and shivering compared with normothermia. The cost of one case of IH was $363.80, and the use of active warming devices might save $152.80. Extra investment in active warming (e.g., $291.00) might only be cost-beneficial when the minimum willingness-to-pay is $150.00. CONCLUSIONS: Synthesized evidence showed that the cost of IH might be overestimated. Furthermore, the value of using active warming devices remains uncertain because the willingness to pay may vary between decision-makers. As not enough awareness of hypothermia prevention in some countries, further research into the clinical use of active warming devices during major surgeries is warranted.

Unmet needs as indicator of improving chronic care delivery system in China.

In 2009, China strengthened its public health service system. Since then, the country has made remarkable achievements in community-based chronic disease prevention and control; however, certain groups still have unmet needs. During 2019 to 2029, China will consolidate the top-level design of its medical health system. During this period, the coordination of department policies, improvement of service delivery mechanisms, building an integrated health service system, and other issues will be highlighted. This study will provide a basis for designing China's chronic disease prevention and control system during the next stage of development. We will consider the unmet needs of patients with chronic diseases as an indicator for remodeling the prediction system in combination with the elements and structural theories of complex health systems. In this article, we first introduce the definition and measurement methods of unmet needs. Second, we identify the existing unmet needs found among patients with chronic diseases with reference to the chronic disease prevention and control policies of China as well as current service items. Finally, we propose the design of community chronic disease service package for the next development stage based on unmet needs of patients with chronic diseases. We also provide suggestions for how to improve China's chronic care delivery system.

Safety of intraoperative hypothermia for patients: meta-analyses of randomized controlled trials and observational studies.

BACKGROUND: Previous studies have shown that intraoperative hypothermia was associated with higher risks of clinical adverse events, but we found otherwise from recent evidences. This study aims to synthesize the existing evidence evaluating safety of intraoperative hypothermia. METHODS: Articles, reviews, ongoing trials and grey literatures were retrieved from PubMed, The Cochrane Library, Clinical Trails and CNKI (a Chinese national database) till February 2nd, 2019. Both randomized controlled trials and observational studies compared incidences of all sorts of intra- and post-operative consequences between hypothermia and normothermia were included. Researches comparing different warming systems were excluded. We also examined risks of hypothermia using lowered standards (35.5 °C and 35 °C) from a Chinese trial (ChiCTR-IPR-17011099). RESULTS: A total of 9 RCT studies and 11 observational studies were included. RCT-synthesized results showed that intraoperative hypothermia was associated with higher risks of bleeding (MD = 131.90, 95%CI: 117.42, 146.38), surgical site infection (RD = 0.14, 95%CI: 0.06, 0.21) and shivering (RD = 0.32, 95%CI: 0.06, 0.58) but with no significant differences in duration of surgery, hospital stay or mortality. Observational study-synthesized evidences showed that intraoperative hypothermia did not result in higher risks in any of these adverse events. Results didn't change even if the standard of hypothermia was lowered by 0.5-1.0 °C. CONCLUSIONS: The study indicates that the synthesized risks resulted by intra-operative hypothermia might be overestimated and the eligibility of 36 °C to define hypothermia is not sensitive enough. Given body-temperature protection has not been popularized in China, it is still critical to normalize the hypothermia prevention at this stage.