An evidence-based whole-process perioperative temperature management protocol for elderly patients undergoing...

Elderly patients undergoing robot-assisted radical prostatectomy (RARP) are vulnerable to perioperative hypothermia. We developed and preliminarily evaluated a whole-process temperature-management protocol. Protocol development comprised evidence synthesis, interviews with 14 healthcare professionals, and two Delphi rounds with 21 experts. The non-concurrent evaluation included 40 control-period patients enrolled in September-October 2025 and 40 intervention-period patients enrolled in November-December 2025. The primary outcome was core-temperature trajectory across 10 measurements; secondary outcomes were hypothermia, shivering, thermal comfort, and satisfaction. The protocol comprised 8 domains, 20 s-level indicators, and 56 third-level indicators. The core-temperature group-by-time interaction was significant [F(2.92, 227.50) = 10.02; P < 0.001]. In a sensitivity analysis restricted to intraoperative nasopharyngeal measurements T1-T5, the interaction remained significant (likelihood-ratio χ²=12.14; df = 4; P = 0.016), with adjusted differences of 0.20-0.36 °C (all Holm-adjusted P ≤ 0.006). Hypothermia occurred in 7.5% versus 27.5% (risk difference, - 20.0% points; 95% CI, - 36.1 to - 3.2), and shivering in 5.0% versus 22.5% (risk difference, - 17.5% points; 95% CI, - 32.9 to - 2.1), during the intervention and control periods, respectively. The protocol was feasible to implement, and outcomes were more favorable during the intervention period. The non-concurrent design limits causal attribution; concurrent randomized studies are needed.