Temperature-comfort discordance and an expert-informed perioperative thermal-management framework in robotic urologic...

Core temperature is central to perioperative hypothermia (PH) prevention, but normothermia may not ensure thermal comfort. We examined temperature-comfort discordance, quantified PH burden, and developed an expert-informed management framework for robotic urologic surgery. This sequential multimethod study comprised three complementary stages. Stage I examined paired temperature-Cold Discomfort Scale states across four post-anesthesia care unit assessments in an 80-patient nonconcurrent controlled cohort. Stage II characterized PH burden and associated factors at 10 peri-anesthetic time points in an independent retrospective cohort of 1,214 patients. Stage III used two-round multidisciplinary consultation with 21 experts to develop the framework. Persistent normothermia-cold-discomfort discordance occurred in 38/40 control-period patients (95.0%) and 27/40 intervention-period patients (67.5%; risk difference, - 27.5% points; 95% CI, - 43.4 to - 10.6; P = 0.003). At post-anesthesia care unit discharge, all 80 patients were normothermic, but 12 (15.0%) reported marked cold discomfort. In Stage II, 507/1,214 patients (41.8%) experienced PH at least once and 360 (29.7%) at two or more time points. Higher pre-anesthesia and ward-measured preoperative patient temperatures were associated with lower PH burden and higher minimum temperature. Higher BMI was associated with higher minimum temperature, whereas total intravenous anesthesia was associated with persistent PH and lower minimum temperature. These directions were unchanged after excluding anesthesia-start temperature and restricting analyses to anesthesia-active measurements. Consultation yielded 18 endorsed actions across five domains. Normothermia and thermal comfort may recover asynchronously, while objective PH remains clinically relevant. Joint consideration of core temperature, patient-reported cold discomfort, and clinical context warrants prospective multicenter evaluation.