Effectiveness of active warming interventions in preventing perioperative hypothermia and its complications in cancer patients: A systematic review and meta-analysis.

BACKGROUND

Perioperative hypothermia is a common complication during cancer surgeries, associated with adverse outcomes such as shivering, prolonged recovery, and increased length of stay (LOS). This systematic review and meta-analysis aimed to assess the effectiveness of active warming interventions in preventing perioperative hypothermia and its complications.

METHODS

In this systematic review and meta-analysis, articles published up to 2025 January 2, were searched in Scopus, PubMed, Web of Science, and Cochrane Library databases. Outcomes measured included perioperative core body temperature, shivering, blood losing, and LOS. Heterogeneity was assessed using the I2 statistic, and publication bias was evaluated with funnel plots and Egger's test. Meta-regression and subgroup analyses explored potential predictors of effectiveness.

RESULTS

Out of 2650 records, 20 articles were included. Active warming techniques improved core body temperature, with a Standard Mean Difference (SMD) of 0.65 at 30 min, increasing to 2.14 at 180 min. Shivering incidence was significantly reduced, with risk differences ranging from -0.12 to -0.25 across interventions. LOS was reduced by an average of 6 h, with a significant difference observed in combined interventions (SMD = -0.80, 95 % CI: 1.23 to -0.37). Heterogeneity was high for pharmaceutical interventions (I2 > 75 %), whereas it remained low for non-pharmacological interventions (I2 < 50 %). Meta-regression revealed participant mean age, %male, BMI, and surgery duration cannot significantly predict the SMD between the two groups.

CONCLUSION

Although, the results of this study show active warming interventions can be effective in preventing perioperative hypothermia complications, more studies with larger samples and higher quality are needed.

STUDY REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420250651763.