{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T13:00:48Z","timestamp":1791464448247,"version":"4.3.4"},"reference-count":46,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,20]],"date-time":"2025-12-20T00:00:00Z","timestamp":1766188800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objective: Intraoperative hypothermia is a common perioperative complication. This large-scale, multicenter, prospective clinical study aimed to delineate the occurrence patterns of intraoperative hypothermia in adults and to identify its major independent risk factors, thereby providing evidence-based support for early clinical risk assessment and intervention. Methods: This study adopted a multicenter, prospective, observational design. Eligible participants were screened based on predefined inclusion and exclusion criteria, and a total of 4516 surgical patients (\u226518 years) from 12 tertiary general hospitals across China were ultimately enrolled. Core body temperature was continuously monitored intraoperatively using standardized methods. Data on demographic characteristics, surgical and anesthesia-related parameters, and perioperative temperature management interventions were collected. Patients were stratified into groups according to the presence or absence of hypothermia (core temperature &lt;36.0 \u00b0C). Univariate analyses were first conducted to identify associated factors, followed by multivariable logistic regression to determine factors independently associated with intraoperative hypothermia. Results: The overall incidence of intraoperative hypothermia among surgical patients was 23.82%. Hypothermia occurred most frequently in patients with a preoperative baseline core temperature \u2264 35.9 \u00b0C (85.93%). Among surgical specialties, hand surgery had the highest incidence of hypothermia (51.35%), and among surgical sites, procedures involving the upper extremities showed the highest rate (35.00%). Multivariable logistic regression analysis identified the following as independent risk factors for intraoperative hypothermia: Type of anesthesia (OR = 1.743, 95% CI: 0.834\u20133.644), ASA classification (OR = 1.408, 95% CI: 1.197\u20131.657), Surgical approach (OR = 0.735, 95% CI: 0.577\u20130.936), Skin disinfection site (OR = 2.024, 95% CI: 1.534\u20132.670), Volume of cold intravenous fluids infused (mL) (OR = 1.365, 95% CI: 1.140\u20131.633), Volume of transfused blood (U) (OR = 1.116, 95% CI: 0.807\u20131.542), Intraoperative blood loss (mL) (OR = 1.252, 95% CI: 0.892\u20131.756), and Duration of surgery (hours) (OR = 2.014, 95% CI: 1.683\u20132.411). Conclusions: The incidence of intraoperative hypothermia in adults was relatively high at 23.82% and was observed to be associated with multiple modifiable perioperative factors. These findings support the need to strengthen risk assessment and implement individualized temperature management strategies in clinical practice, with the goal of reducing the risk of intraoperative hypothermia and improving perioperative safety and outcomes.<\/jats:p>","DOI":"10.3390\/jcm15010031","type":"journal-article","created":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T11:43:31Z","timestamp":1766403811000},"page":"31","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Characteristics and Risk Factors of Intraoperative Hypothermia in Adults: A Multicenter Prospective Observational Clinical Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-0528-7322","authenticated-orcid":false,"given":"Hanqing","family":"Zhang","sequence":"first","affiliation":[{"name":"Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China"},{"name":"School of Nursing, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinglian","family":"Gao","sequence":"additional","affiliation":[{"name":"Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wen","family":"Ke","sequence":"additional","affiliation":[{"name":"Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zengyan","family":"Wang","sequence":"additional","affiliation":[{"name":"Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiong","family":"Ma","sequence":"additional","affiliation":[{"name":"Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenjing","family":"Yu","sequence":"additional","affiliation":[{"name":"Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juanjuan","family":"Hu","sequence":"additional","affiliation":[{"name":"Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the Intraoperative Hypothermia Investigators (12-Center Consortium)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1007\/s44254-023-00022-6","article-title":"Inadvertent hypothermia: A prevalent perioperative issue that remains to be improved","volume":"1","author":"Wang","year":"2023","journal-title":"Anesthesiol. Perioper. Sci."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1016\/j.bpa.2008.07.005","article-title":"Perioperative complications of hypothermia","volume":"22","author":"Reynolds","year":"2008","journal-title":"Best Pract. Res. Clin. Anaesthesiol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"873","DOI":"10.1016\/j.jtcvs.2023.10.011","article-title":"Impact of intraoperative blood products, fluid administration, and persistent hypothermia on bleeding leading to reexploration after cardiac surgery","volume":"168","author":"Shou","year":"2024","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1016\/j.bjae.2018.05.003","article-title":"Inadvertent perioperative hypothermia","volume":"18","author":"Riley","year":"2018","journal-title":"BJA Educ."},{"key":"ref_5","first-page":"281","article-title":"Compliance of Health Professionals for Prevention of Inadvertent Perioperative Hypothermia in Adult Patients: A Review","volume":"90","author":"Oden","year":"2022","journal-title":"Aana J."},{"key":"ref_6","first-page":"43","article-title":"Development and validation of an adult intraoperative hypothermia risk assessment scale","volume":"37","author":"Wen","year":"2022","journal-title":"J. Nurs. Sci."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Rauch, S., Miller, C., Br\u00e4uer, A., Wallner, B., Bock, M., and Paal, P. (2021). Perioperative Hypothermia-A Narrative Review. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18168749"},{"key":"ref_8","first-page":"Cd009016","article-title":"Active body surface warming systems for preventing complications caused by inadvertent perioperative hypothermia in adults","volume":"4","author":"Madrid","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"211","DOI":"10.17085\/apm.2016.11.2.211","article-title":"Effect of electrically heated humidifier on intraoperative core body temperature decrease in elderly patients: A prospective observational study","volume":"11","author":"Seo","year":"2016","journal-title":"Anesth. Pain Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"175","DOI":"10.4235\/agmr.22.0053","article-title":"Prewarming for Prevention of Hypothermia in Older Patients Undergoing Hand Surgery Under Brachial Plexus Block","volume":"26","author":"Cho","year":"2022","journal-title":"Ann. Geriatr. Med. Res."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Wang, J., Fang, P., Sun, G., and Li, M. (2022). Effect of active forced air warming during the first hour after anesthesia induction and intraoperation avoids hypothermia in elderly patients. BMC Anesth., 22.","DOI":"10.1186\/s12871-022-01577-w"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"424","DOI":"10.4103\/0970-9185.168174","article-title":"Tourniquet application during anesthesia: \u201cWhat we need to know?\u201d","volume":"32","author":"Kumar","year":"2016","journal-title":"J. Anaesthesiol. Clin. Pharmacol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"van Veelen, M.J., and Brodmann Maeder, M. (2021). Hypothermia in Trauma. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18168719"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Duryea, E.L., Nelson, D.B., Wyckoff, M.H., Grant, E.N., Tao, W., Sadana, N., Chalak, L.F., McIntire, D.D., and Leveno, K.J. (2016). The impact of ambient operating room temperature on neonatal and maternal hypothermia and associated morbidities: A randomized controlled trial. Am. J. Obs. Gynecol., 214.","DOI":"10.1016\/j.ajog.2016.01.190"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1177\/10547738221090593","article-title":"The Effects of Active Warming on Core Body Temperature and Thermal Comfort in Patients After Transurethral Resection of the Prostate: A Randomized Clinical Trial","volume":"32","author":"Khorshid","year":"2023","journal-title":"Clin. Nurs. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/s11552-010-9312-6","article-title":"Tourniquet use in upper limb surgery","volume":"6","author":"Oragui","year":"2011","journal-title":"Hand"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/j.ijnurstu.2013.05.013","article-title":"Warming with an underbody warming system reduces intraoperative hypothermia in patients undergoing laparoscopic gastrointestinal surgery: A randomized controlled study","volume":"51","author":"Pu","year":"2014","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e200","DOI":"10.2106\/JBJS.N.00054","article-title":"Forced air warming devices in orthopaedics: A focused review of the literature","volume":"96","author":"Sikka","year":"2014","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.bpa.2007.10.004","article-title":"Thermal care in the perioperative period","volume":"22","author":"Kurz","year":"2008","journal-title":"Best Pract. Res. Clin. Anaesthesiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"771","DOI":"10.1152\/japplphysiol.00527.2015","article-title":"Sympathetic control of reflex cutaneous vasoconstriction in human aging","volume":"119","author":"Greaney","year":"2015","journal-title":"J. Appl. Physiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"37","DOI":"10.7600\/jpfsm.2.37","article-title":"Aging and thermoregulation","volume":"2","author":"Shibasaki","year":"2013","journal-title":"J. Phys. Fit. Sports Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"474","DOI":"10.4103\/sja.sja_579_23","article-title":"Implication of age-related changes on anesthesia management","volume":"17","author":"Luca","year":"2023","journal-title":"Saudi J. Anaesth."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1097\/ALN.0b013e31817f6d76","article-title":"Temperature monitoring and perioperative thermoregulation","volume":"109","author":"Sessler","year":"2008","journal-title":"Anesthesiology"},{"key":"ref_24","first-page":"e17128","article-title":"Mean Temperature Loss During General Anesthesia for Laparoscopic Cholecystectomy: Comparison of Males and Females","volume":"13","author":"Ahmed","year":"2021","journal-title":"Cureus"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1007\/s12576-009-0079-x","article-title":"Estrogen modulates central and peripheral responses to cold in female rats","volume":"60","author":"Uchida","year":"2010","journal-title":"J. Physiol. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Chen, H.Y., Su, L.J., Wu, H.Z., Zou, H., Yang, R., and Zhu, Y.X. (2021). Risk factors for inadvertent intraoperative hypothermia in patients undergoing laparoscopic surgery: A prospective cohort study. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0257816"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/B978-0-444-63912-7.00026-6","article-title":"Obesity and thermoregulation","volume":"156","author":"Speakman","year":"2018","journal-title":"Handb. Clin. Neurol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1717","DOI":"10.2147\/TCRM.S122700","article-title":"The effect of body mass index on perioperative thermoregulation","volume":"12","author":"Erhan","year":"2016","journal-title":"Ther. Clin. Risk Manag."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/j.jclinane.2016.06.030","article-title":"Active perioperative patient warming using a self-warming blanket (BARRIER EasyWarm) is superior to passive thermal insulation: A multinational, multicenter, randomized trial","volume":"34","author":"Torossian","year":"2016","journal-title":"J. Clin. Anesth."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Bender, M., Self, B., Schroeder, E., and Giap, B. (2015). Comparing new-technology passive warming versus traditional passive warming methods for optimizing perioperative body core temperature. Aorn J., 102.","DOI":"10.1016\/j.aorn.2015.06.005"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"249","DOI":"10.1093\/bja\/aev412","article-title":"Comparison of resistive heating and forced-air warming to prevent inadvertent perioperative hypothermia","volume":"116","author":"John","year":"2016","journal-title":"Br. J. Anaesth."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"22356","DOI":"10.1038\/s41598-025-04644-7","article-title":"Comparing warming strategies to reduce hypothermia and shivering in elderly abdominal or pelvic surgery patients: A network meta-analysis","volume":"15","author":"Zheng","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"775","DOI":"10.1007\/s11060-025-05174-y","article-title":"Surgical outcomes in octogenarian meningioma patients: A multicenter retrospective analysis of frailty and radiological predictors: Frailty in octogenarians undergoing meningioma resection","volume":"175","author":"Lagares","year":"2025","journal-title":"J. Neurooncol."},{"key":"ref_34","first-page":"166","article-title":"Preventing inadvertent perioperative hypothermia","volume":"112","author":"Torossian","year":"2015","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e14103","DOI":"10.1111\/ijcp.14103","article-title":"The incidence of inadvertent perioperative hypothermia in patients undergoing general anesthesia and an examination of risk factors","volume":"75","author":"Sari","year":"2021","journal-title":"Int. J. Clin. Pract."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1186\/s13756-015-0084-1","article-title":"The effect of preheated versus room-temperature skin disinfection on bacterial colonization during pacemaker device implantation: A randomized controlled non-inferiority trial","volume":"4","author":"Wistrand","year":"2015","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"ref_37","first-page":"Cd009891","article-title":"Warming of intravenous and irrigation fluids for preventing inadvertent perioperative hypothermia","volume":"2015","author":"Campbell","year":"2015","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"4443","DOI":"10.2147\/JMDH.S538891","article-title":"Risk Prediction Models for Perioperative Hypothermia: A Systematic Review","volume":"18","author":"Liu","year":"2025","journal-title":"J. Multidiscip. Healthc."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Fan, B., Li, B., Wang, Z., Wu, H., Huang, L., and Liu, S. (2025). The prevalence and risk factors of intraoperative hypothermia in patients with hip\/knee arthroplasty: A systematic review and meta-analysis. BMC Musculoskelet. Disord., 26.","DOI":"10.1186\/s12891-025-08962-9"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"189","DOI":"10.17085\/apm.25294","article-title":"Cold temperatures, hot risks: Perioperative hypothermia in geriatric patients\u2014A narrative review","volume":"20","author":"Yoo","year":"2025","journal-title":"Anesth. Pain Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2655","DOI":"10.1016\/S0140-6736(15)00981-2","article-title":"Perioperative thermoregulation and heat balance","volume":"387","author":"Sessler","year":"2016","journal-title":"Lancet"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"123","DOI":"10.29271\/jcpsp.2020.02.123","article-title":"Inadvertent Perioperative Hypothermia and Important Risk Factors during Major Abdominal Surgeries","volume":"30","author":"Sagiroglu","year":"2020","journal-title":"J. Coll. Physicians Surg. Pak."},{"key":"ref_43","first-page":"983","article-title":"Incidence of Postoperative Hypothermia and Factors Effecting the Development of Hypothermia in Patients Undergoing Abdominal Surgery","volume":"14","author":"Aldemir","year":"2021","journal-title":"Int. J. Caring Sci."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1097\/TA.0b013e31825c163b","article-title":"Hypothermia in massive transfusion: Have we been paying enough attention to it?","volume":"73","author":"Reynolds","year":"2012","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.1016\/j.jtcvs.2010.07.098","article-title":"Predictors of massive transfusion with thoracic aortic procedures involving deep hypothermic circulatory arrest","volume":"141","author":"Williams","year":"2011","journal-title":"J. Thorac Cardiovasc. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"991","DOI":"10.62347\/YXHG6188","article-title":"Effects of warming needle moxibustion on postoperative rehabilitation, pain degree, immune function, and upper limb lymphedema in patients with breast cancer undergoing radical mastectomy","volume":"15","author":"Zheng","year":"2025","journal-title":"Am. J. Cancer Res."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/31\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T11:42:18Z","timestamp":1766576538000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/1\/31"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,20]]},"references-count":46,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15010031"],"URL":"https:\/\/doi.org\/10.3390\/jcm15010031","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,20]]}}}