Critical Care KOL News Update: Warming Protocols As Predictors Of Postoperative Hypothermia In Ovarian Cancer Surgery

Perioperative hypothermia – defined as a core body temperature below 36.0°C – is a common but preventable complication associated with increased morbidity and delayed recovery in surgical oncology patients. Hypothermia increases the risk of surgical site infection (SSI), impairs coagulation, prolongs recovery and increases healthcare costs. International guidelines, including those from AORN, recommend active warming strategies and maintaining odds ratio (OR) temperatures ≥ 21°C to mitigate these risks. ^1-3

While extensive data supports active warming interventions in general surgical populations, their application in gynaecological oncology – particularly ovarian cancer cytoreductive surgery – remains understudied. Such procedures often involve prolonged exposure, high fluid volumes and extensive dissection, all of which contribute to thermoregulatory instability. ^{4, 5}

To address the gaps in evidence, a retrospective study has been carried out involving 245 ovarian cancer patients who underwent cytoreductive surgery between 2014 and 2022. This research investigates the incidence of postoperative hypothermia, explores predictors, such as intraoperative warming protocols and OR ambient temperature, and evaluates associations with recovery outcomes, length of stay and readmission rates. Of those patients included in the study, 97 developed postoperative hypothermia, while 148 maintained normothermia. The overall incidence of hypothermia (core temperature < 36.0°C at the end of surgery) was 39.6%, highlighting the substantial prevalence of this preventable complication in a high-risk oncologic surgical population. Full details of the recently published study can be found at https://pubmed.ncbi.nlm.nih.gov/41630324/

The study states: “The incidence of postoperative hypothermia varied significantly by thermal management strategy” – see Table 2 in the study report. “Among patients who received any form of active warming (forced-air or prewarming combined), the hypothermia rate was markedly lower compared to those without warming (25.3% vs 69.6%, P < .001). Stratified analysis further showed that patients who received prewarming in addition to forced-air warming had the lowest incidence of hypothermia (23.4%).” Ovarian cytoreductive surgery involves procedures that substantially increase conductive and evaporative heat loss. ⁶ Recent multicentre gynaecological studies have reported intraoperative hypothermia incidences of approximately 45% across gynaecological surgeries, ⁷ with even higher risks documented among patients undergoing ovarian cancer cytoreduction because of prolonged operative times and extensive visceral exposure. ⁸

The results of the study indicate that ovarian cancer cytoreduction represents a particularly high-risk surgical setting for perioperative hypothermia. The findings support the implementation of comprehensive, nurse-led thermal care protocols, incorporating prewarming, intraoperative forced-air warming and ambient temperature control, which are essential for optimising surgical outcomes and should be integrated into standardised ERAS pathways.

Effective patient warming has been shown to be vital in helping prevent hypothermia. As the UK distributor for a number of temperature management brands, Central Medical Supplies (CMS) offers a wide range of temperature management solutions and is committed to assisting healthcare professionals in keeping patients at the correct temperature. The company is the exclusive UK distributor for the Kanmed WarmCloud, a unique patient warming system with built-in pressure sore prevention. Designed to maintain an optimal body temperature during surgery, the Kanmed WarmCloud system consists of a single-use warm air mattress, a main unit and an optional remote control for operating the system. The warm air mattress is placed under the patient, creating a soft, comfortable and temperature-controlled environment, while enabling surgeons to still have easy access to surgical sites.

For advice on temperature management, along with Kanmed WarmCloud product information, contact Sarah Ward, Brand and Product Manager at Central Medical Supplies, on 07985 425 397 or email sarah.ward@centralmedical.co.uk. Alternatively, you can find out more by visiting www.centralmedical.co.uk.

1. Oden TN, Celikturk Doruker N, Demir Korkmaz F. Perioperative health care professionals’ knowledge of evidence-based inadvertent perioperative hypothermia management. J Perianesth Nurs. 2024;39:789-94.
2. Young JM, Couch K. Improving safe thermoregulation practices in an urban outpatient surgery centre through a quality improvement initiative. J Perianesth Nurs. 2025;40:1147-53.
3. Akdag Topal C, Yucel Ozcirpan C, Ozyuncu O. The effect of forced-air warming in the caesarean section on maternal hypothermia, shivering, and thermal comfort: a radomised controlled trial. Health Care Women Int. 2024;45:1016-33.
4. Cho SA, Yoon S, Lee SJ, Jee YS, Cho CK, Sung TY. Clinical efficacy of short-term prewarming in elderly and adult patients: a prospective observational study. Int J Med Sci. 2022;19:1548-56.
5. Kostov S, Selcuk I, Watrowski R, et al. Neglected anatomical areas in ovarian cancer: significance for optimal debulking surgery. Cancers (Basel). 2024;16:285.
6. Laios A, Kalampokis E, Mamalis ME, et al. Exploring the potential role of upper abdominal peritonectomy in advanced ovarian cancer cytoreductive surgery using explainable artificial intelligence. Cancers (Basel). 2023;15:5386.
7. Cao B, Li Y, Liu Y, et al. A multi-centre study to predict the risk of intraoperative hypothermia in gynaecological surgery patients using pre-operative variables. Gynecol Oncol. 2024;185:156-64.
8. Theodoulidis V, Kissoudi K, Chatzistamatiou K, et al. Predictors of extended intensive care unit utilisation after ovarian cancer surgery. Cancers (Basel). 2025;17:3203.