Operating-room temperature and warming protocols as predictors of postoperative hypothermia in ovarian cancer surgery: A retrospective cohort study
Perioperative hypothermia is a common but preventable complication associated with increased morbidity and delayed recovery in surgical oncology patients. However, limited evidence exists regarding its prevalence, predictors, and consequences in women undergoing cytoreductive surgery for ovarian cancer. This retrospective cohort study included 245 patients who underwent primary or interval cytoreductive surgery for epithelial ovarian cancer at a tertiary care center between 2014 and 2022. Patients were stratified into normothermia (≥36.0°C) and hypothermia (<36.0°C) groups based on core temperature at surgical closure. Intraoperative warming strategies and operating-room temperature were recorded. Multivariate logistic regression was used to identify independent predictors of postoperative hypothermia. Postoperative outcomes were compared between groups. Postoperative hypothermia occurred in 39.6% of patients. Independent risk factors included age ≥ 60 years (odds ratio [OR] 1.89,
P
= .025), body mass index < 22 kg/m² (OR 1.96,
P
= .022), American Society of Anesthesiologists class III–IV (OR 2.05,
P
= .020), ascites volume > 500 mL (OR 1.97,
P
= .031), operative time ≥ 240 minutes (OR 2.92,
P
= .001), blood loss ≥ 400 mL (OR 2.23,
P
= .011), absence of active warming (OR 4.12,
P
< .001), and OR temperature < 22°C (OR 2.47,
P
= .005). Hypothermia was associated with higher rates of shivering (40.2% vs 12.2%,
P
< .001), surgical site infection (16.5% vs 6.8%,
P
= .019), longer time to ambulation and gastrointestinal recovery, prolonged hospital stay, and increased 30-day readmission. Postoperative hypothermia is highly prevalent and clinically significant among ovarian cancer patients undergoing cytoreductive surgery. Intraoperative warming strategies and maintaining adequate OR temperatures play critical roles in prevention. These findings highlight the importance of standardized thermal care protocols led by perioperative nursing teams to improve surgical outcomes. These conclusions apply to female patients only, as the cohort exclusively comprised women undergoing ovarian cancer cytoreductive surgery.
