Keeping your cool - a simple reusable neck cooler in orthopaedic surgery: a pilot randomized controlled trial

Background Infection in orthopaedic surgery can be catastrophic. Increased perspiration from theatre staff has been associated with higher rates of wound contamination. Wearing lead safety gowns, which is often done during surgery to allow the use of image intensifier, may result in heavy perspiration. This study aimed to determine the feasibility of wearing a neck cooling device during surgery and whether it reduced surgeons' subjective discomfort and perspiration levels during orthopaedic procedures requiring the use of lead gowns. Methods A pilot randomized controlled trial was conducted. Surgeons were randomized to either wearing the neck cooling device (intervention) or not wearing the device (control). Procedure duration, theatre temperature, humidity and perceived technical difficulty of operation were recorded. After the procedure, surgeons completed a questionnaire documenting how the temperature and humidity had a negative effect on their comfort and perceived level of perspiration. Multilevel mixed effects linear regression with random effects, adjusting for potential confounders was performed. Alfred Ethics Committee approved the study and the trial was registered (ACTRN12618000976280). Results A total of 29 cases (44.6%) were randomized to the intervention group and 36 to the control group. Adjusting for operating room temperature and perceived difficulty of surgery, the neck cooler reduced surgeons' level of discomfort by 1.9 points (95% CI 1.1-2.8, P < 0.001), as well improved on their self-reported perspiration by approximately 1.9 points (95% CI 1.0-2.8, P = 0.04). Conclusions Wearing a neck cooling device during surgery is feasible, reduces perceived levels of perspiration and decreases the negative impact of temperature and humidity on surgeons' comfort levels.