The effect of active warming and conventional body temperature management on perioperative blood loss and coagulation function in patients undergoing scoliosis correction: a multicenter randomized controlled trial.

BACKGROUND

Idiopathic scoliosis correction surgery is complex and associated with significant perioperative blood loss. Adolescent patients are particularly susceptible to hypothermia due to physiological characteristics, which may exacerbate coagulopathy and increase the risk of adverse events. This prospective multicenter randomized controlled trial aimed to evaluate the impact of active warming on perioperative blood loss and coagulation function in this patient population.

METHODS

A total of 374 patients scheduled for elective scoliosis correction surgery were randomized into an active warming group (n = 187) and a standard temperature management group (n = 187). The active warming protocol included preoperative warming, intraoperative forced-air warming, and warmed intravenous fluids, whereas the control group received warming interventions only when core temperature dropped below 35.5℃. Perioperative blood loss, laboratory coagulation indices, and body temperature data were collected. Statistical analyses included chi-square test, Wilcoxon rank-sum test, and t-test to compare outcomes between groups.

RESULTS

The total blood loss was significantly lower in the active warming group compared to the standard care group (610.22(576.03 ~ 644.41) mL vs. 704.59(657.30 ~ 751.88)mL, P = 0.002). Hidden blood loss and allogeneic transfusion volumes were also significantly reduced (P < 0.001). Patients receiving active warming maintained higher minimum and maximum intraoperative temperatures, with a reduced incidence of hypothermia and postoperative shivering (P < 0.001). Extubation time was shorter in the active warming group (20.77(20.1 ~ 21.44)vs. 24.60(23.98 ~ 25.22), P < 0.001). Additionally, length of hospital stay and hospitalization costs were significantly lower (P < 0.001).

CONCLUSIONS

Active warming effectively reduced perioperative blood loss and improves temperature-related outcomes in patients undergoing idiopathic scoliosis correction surgery. This strategy facilitated postoperative recovery and supported the standardization of temperature management protocols in clinical practice.

TRIAL REGISTRATION NUMBER: This study was registered with the Chinese Clinical Trial Registry (ChiCTR2400092945) on 26 November, 2024 and it was approved by the ethics committee. All participants signed the informed consent form.