Association Between Preoperative Core Temperature and Postoperative Mortality in Patients with Major Burns

Background and Objectives: Major burn injury causes profound hypermetabolism and altered thermoregulation. While perioperative hypothermia is linked to adverse outcomes, the prognostic significance of preoperative core temperature in major burn patients remains poorly defined. Therefore, we investigated the association between preoperative core temperature and postoperative mortality in patients with major burns. Materials and Methods: This retrospective study included 635 adult patients with major burns who underwent surgery. Preoperative core temperature was measured in the intensive care unit before surgery. The primary outcome was 90-day postoperative mortality. Secondary outcomes were 30-day postoperative complications, including major adverse cardiovascular events (MACE), bloodstream infection, and continuous renal replacement therapy (CRRT) requirement. Cox proportional hazards regression, receiver operating characteristic (ROC) curve, Kaplan-Meier survival, and restricted cubic spline analyses were performed. Results: The 90-day postoperative mortality rate was 35.6%. Mortality increased in a graded manner as preoperative core temperature decreased. In multivariable Cox regression analysis, preoperative core temperature remained independently associated with 90-day mortality. Restricted cubic spline analysis showed an inverse linear association between preoperative core temperature and mortality risk. ROC curve analysis identified 37.0 °C as an exploratory and hypothesis-generating cohort-specific threshold for risk stratification. Regarding secondary outcomes, the core temperature ≤37.0 °C group had higher rates of MACE, bloodstream infections, and CRRT requirement (all p < 0.05). Conclusions: Lower preoperative core temperature was associated with increased 90-day postoperative mortality in adults with major burns undergoing surgery. Preoperative temperature may serve as a clinically relevant marker of physiologic vulnerability and postoperative risk.