The prevalence and risk factors of intraoperative hypothermia in patients with hip/knee arthroplasty: a systematic review and meta-analysis

Abstract Background Intraoperative hypothermia (IOH) is common among patients undergoing total joint arthroplasty (TJA) of the lower extremities. Evaluating the risk factors for IOH is critical for the success of preventive interventions. This study aims to systematically assess the prevalence and r...

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Main Authors: Bingxin Fan, Boliang Li, Zhi Wang, Hao Wu, Li Huang, Surong Liu
Format: Article
Language:English
Published: BMC 2025-07-01
Series:BMC Musculoskeletal Disorders
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Online Access:https://doi.org/10.1186/s12891-025-08962-9
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author Bingxin Fan
Boliang Li
Zhi Wang
Hao Wu
Li Huang
Surong Liu
author_facet Bingxin Fan
Boliang Li
Zhi Wang
Hao Wu
Li Huang
Surong Liu
author_sort Bingxin Fan
collection DOAJ
description Abstract Background Intraoperative hypothermia (IOH) is common among patients undergoing total joint arthroplasty (TJA) of the lower extremities. Evaluating the risk factors for IOH is critical for the success of preventive interventions. This study aims to systematically assess the prevalence and risk factors of IOH in TJA patients. Design Systematic review and meta-analysis. Methods Two independent researchers conducted a literature search across eight databases: PubMed, Web of Science, Embase, Cochrane Library, CNKI, VIP, WANFANG Data, and CBM. The quality of included studies was assessed using the Newcastle-Ottawa Scale. A random-effects model was employed to analyze the prevalence and risk factors of IOH. All analyses were performed using Stata 12.0 software. Results Across 21 cohort studies on TJA patients, the pooled prevalence of IOH was 35.28% (95% CI: 27.50%-43.48%). Subgroup analysis revealed an IOH prevalence of 38.66% (95% CI: 28.67%-49.16%) in THA patients and 27.23% (95% CI: 18.37%- 37.11%) in TKA patients. Significant risk factors for IOH included intraoperative blood loss, intraoperative infusion volume, operating room temperature, and surgical time. Current evidence does not support a clear association between patient age, anesthesia time, and IOH. Conclusion Our Meta-analysis indicates that the prevalence of IOH is high among TJA patients, despite significant heterogeneity (I² =98.7%, τ²= 0.15), the pooled analysis suggested the prevalence of IOH in TJA patients was 35.28% (95% CI: 27.50%-43.48%). However, the interpretation of these findings should be cautious due to substantial variability across studies. Additionally, assessment of intraoperative blood loss, infusion volume, operating room temperature, and surgical time should be integral to IOH risk evaluation in TJA patients. Future studies are needed to further explore the roles of age and anesthesia time as potential risk factors. Tailored IOH prevention strategies should be developed by addressing modifiable risk factors. Trial registration PROSPERO Registration ID: CRD42024559846
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spelling doaj-art-de09a98c98e746c1b20d3c8d8b72f7392025-08-20T03:42:19ZengBMCBMC Musculoskeletal Disorders1471-24742025-07-0126111510.1186/s12891-025-08962-9The prevalence and risk factors of intraoperative hypothermia in patients with hip/knee arthroplasty: a systematic review and meta-analysisBingxin Fan0Boliang Li1Zhi Wang2Hao Wu3Li Huang4Surong Liu5School of Nursing, Chengdu University of Traditional Chinese MedicineDepartment of Health Statistics, School of Public Health, Dalian Medical UniversitySchool of Nursing, Chengdu University of Traditional Chinese MedicineChengdu Integrated TCM and Western Medicine Hospital (Chengdu First People’s Hospital)Chengdu Integrated TCM and Western Medicine Hospital (Chengdu First People’s Hospital)Chengdu Integrated TCM and Western Medicine Hospital (Chengdu First People’s Hospital)Abstract Background Intraoperative hypothermia (IOH) is common among patients undergoing total joint arthroplasty (TJA) of the lower extremities. Evaluating the risk factors for IOH is critical for the success of preventive interventions. This study aims to systematically assess the prevalence and risk factors of IOH in TJA patients. Design Systematic review and meta-analysis. Methods Two independent researchers conducted a literature search across eight databases: PubMed, Web of Science, Embase, Cochrane Library, CNKI, VIP, WANFANG Data, and CBM. The quality of included studies was assessed using the Newcastle-Ottawa Scale. A random-effects model was employed to analyze the prevalence and risk factors of IOH. All analyses were performed using Stata 12.0 software. Results Across 21 cohort studies on TJA patients, the pooled prevalence of IOH was 35.28% (95% CI: 27.50%-43.48%). Subgroup analysis revealed an IOH prevalence of 38.66% (95% CI: 28.67%-49.16%) in THA patients and 27.23% (95% CI: 18.37%- 37.11%) in TKA patients. Significant risk factors for IOH included intraoperative blood loss, intraoperative infusion volume, operating room temperature, and surgical time. Current evidence does not support a clear association between patient age, anesthesia time, and IOH. Conclusion Our Meta-analysis indicates that the prevalence of IOH is high among TJA patients, despite significant heterogeneity (I² =98.7%, τ²= 0.15), the pooled analysis suggested the prevalence of IOH in TJA patients was 35.28% (95% CI: 27.50%-43.48%). However, the interpretation of these findings should be cautious due to substantial variability across studies. Additionally, assessment of intraoperative blood loss, infusion volume, operating room temperature, and surgical time should be integral to IOH risk evaluation in TJA patients. Future studies are needed to further explore the roles of age and anesthesia time as potential risk factors. Tailored IOH prevention strategies should be developed by addressing modifiable risk factors. Trial registration PROSPERO Registration ID: CRD42024559846https://doi.org/10.1186/s12891-025-08962-9Intraoperative hypothermiaTHATKAPrevalenceRisk factorsMeta-analysis
spellingShingle Bingxin Fan
Boliang Li
Zhi Wang
Hao Wu
Li Huang
Surong Liu
The prevalence and risk factors of intraoperative hypothermia in patients with hip/knee arthroplasty: a systematic review and meta-analysis
BMC Musculoskeletal Disorders
Intraoperative hypothermia
THA
TKA
Prevalence
Risk factors
Meta-analysis
title The prevalence and risk factors of intraoperative hypothermia in patients with hip/knee arthroplasty: a systematic review and meta-analysis
title_full The prevalence and risk factors of intraoperative hypothermia in patients with hip/knee arthroplasty: a systematic review and meta-analysis
title_fullStr The prevalence and risk factors of intraoperative hypothermia in patients with hip/knee arthroplasty: a systematic review and meta-analysis
title_full_unstemmed The prevalence and risk factors of intraoperative hypothermia in patients with hip/knee arthroplasty: a systematic review and meta-analysis
title_short The prevalence and risk factors of intraoperative hypothermia in patients with hip/knee arthroplasty: a systematic review and meta-analysis
title_sort prevalence and risk factors of intraoperative hypothermia in patients with hip knee arthroplasty a systematic review and meta analysis
topic Intraoperative hypothermia
THA
TKA
Prevalence
Risk factors
Meta-analysis
url https://doi.org/10.1186/s12891-025-08962-9
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