Analysis of risk factors for perioperative hypothermia in patients undergoing spinal trauma surgery

To investigate the independent risk factors for perioperative hypothermia in patients undergoing spinal trauma surgery, and to provide evidence-based support for developing targeted preventive strategies.

A retrospective cohort study was conducted, including 222 patients who underwent spinal trauma surgery at a single hospital between January 2022 and December 2024. Patients were divided into a hypothermia group (n = 98) and a non-hypothermia group (n = 124) based on whether perioperative hypothermia (core body temperature < 36.0 °C) occurred. Data on patient demographics, clinical characteristics, surgical parameters, and temperature management measures were collected. Univariate analysis was first performed to compare differences between the groups. Variables with statistical significance in the univariate analysis were then included in a multivariate Logistic regression model (forward stepwise method) to identify independent risk factors. Sensitivity analysis was conducted to test the robustness of the results.

Multivariate Logistic regression analysis showed that age ≥ 60 years (OR = 5.00, 95% CI: 2.24-11.16, P < 0.001), BMI ≤ 24 kg/m² (OR = 2.98, 95% CI: 1.36-6.52, P = 0.006), operation time ≥ 4 h (OR = 4.37, 95% CI: 1.58-12.09, P = 0.005), intraoperative blood loss ≥ 200 mL (OR = 3.74, 95% CI: 1.45-9.66, P = 0.007), intraoperative fluid infusion ≥ 3500 mL (OR = 5.64, 95% CI: 1.99-15.98, P < 0.001), and the use of physical warming alone (compared to combined physical and pharmacological warming) (OR = 2.20, 95% CI: 1.05-4.60, P = 0.036) were independently associated with perioperative hypothermia. Sensitivity analysis confirmed the robustness of these associations.

In this retrospective cohort, advanced age, low BMI, prolonged operation time, significant intraoperative blood loss and fluid infusion, and the use of single‑method physical warming were independently associated with perioperative hypothermia in patients undergoing spinal trauma surgery. These associations do not imply causality due to the observational design and potential residual confounding. Prospective studies, particularly randomized controlled trials where ethically and practically feasible, are needed to confirm causal relationships. Clinicians may use them for risk stratification but should not assume direct protective effects of specific interventions.