We must ask relevant questions and answer with meaningful
Ronald B. George, MD, FRCPC
Dolores M. McKeen, MD, MSc, FRCPC
Received: 30 May 2017 / Accepted: 12 June 2017 / Published online: 16 June 2017
Ó Canadian Anesthesiologists’ Society 2017
‘‘Nobody knew that health care could be so complicated’’,
is how United States President Donald Trump portrayed his
ﬁrst month’s experience with healthcare policy when he
addressed a group of governors at the White House on
February 27, 2017.
Most anybody working in healthcare could have let
President Trump in on our poorly kept secret – healthcare
is complicated! In fact, healthcare is very complicated, and
in speciﬁc situations, a lack of standardized end points and
patient-centred outcome measures can contribute to this
complicated state of affairs. Relevant patient-centred
outcome measures should be validated, have clinical
meaning (i.e., personal value to patients), and result in
improved care or facilitate positive healthcare experience -
but in certain circumstances, they can get complicated.
In this issue of the Journal, Desgranges et al.
the ﬁndings of their prospective cohort study examining the
predictive factors of maternal hypothermia during
Cesarean delivery. In their study, the authors monitored
the tympanic temperatures of women who were scheduled
for either elective or emergency Cesarean delivery.
Temperature was measured upon arrival in the operating
room, at skin incision, and at the end of the skin closure.
Cesarean deliveries performed under either neuraxial or
general anesthesia were included.
After induction of anesthesia, patients were kept warm
with a cotton blanket over their upper body and with an
upper body forced-air warmer set at 43°C. Hypothermia
was deﬁned as a tympanic temperature \36°C at the end of
the skin suture. Various demographic, preoperative, and
intraoperative surgical and anesthetic factors were recorded
and analyzed as possible predictors of maternal
hypothermia. Three hundred ﬁfty-nine women were
included in the analysis, and 23% of these patients
experienced hypothermia. The investigators’ analysis
showed that the use of active forced-air warming was
associated with a decreased risk for maternal hypothermia,
while a lower maternal temperature upon arrival in the
operating room as well as an increased volume of un-
warmed intravenous ﬂuids were predictors of maternal
hypothermia. Desgranges et al. suggest their results should
encourage each anesthesiologist to monitor maternal
temperature before and during Cesarean delivery, since
maternal hypothermia may lead to several complications.
Nevertheless, readers should consider the following
fundamental question after reading the Desgranges et al.
study: What is the relevance of the clinical problem of
maternal hypothermia during Cesarean delivery with
regard to the patient? Applying the FINER criteria
(feasible, interesting, novel, ethical, and relevant)
clinical researchers seek to provide answers. When
presented with clinical problems, we ask questions,
explain the facts, and analyze the data in order to offer
possible solutions. Too often, we do not have patient-
centred outcomes relevant to our question.
Desgranges et al.
state, ‘‘While there is some evidence
that intraoperative hypothermia may contribute to
perioperative morbidity in the general surgical
population, there is a lack of data in the literature as to
the potential consequences of maternal hypothermia during
[Cesarean delivery] on perioperative maternal and neonatal
outcomes.’’ Interpretation of clinical trial outcomes needs
R. B. George, MD, FRCPC Á D. M. McKeen, MD, MSc,
Department of Women’s & Obstetric Anesthesia, IWK Health
Centre, Dalhousie University, 5850/5980 University Avenue,
P.O. Box 9700, Halifax, NS B3K 6R8, Canada
Can J Anesth/J Can Anesth (2017) 64:899–903