Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Comparative Study
. 2025 Jul 1;15(1):22356.
doi: 10.1038/s41598-025-04644-7.

Comparing warming strategies to reduce hypothermia and shivering in elderly abdominal or pelvic surgery patients: a network meta-analysis

Wenyun Zheng  1 , Bin Huang  2 , Li Bao  3 , Jun Wang  4 , Jingfen Jin  5
Affiliations
Comparative Study

Comparing warming strategies to reduce hypothermia and shivering in elderly abdominal or pelvic surgery patients: a network meta-analysis

Wenyun Zheng et al. Sci Rep. .

Abstract

Perioperative hypothermia (PHT) and shivering represent significant clinical challenges in geriatric surgical populations. This network meta-analysis (NMA) systematically evaluates the comparative efficacy of various warming interventions in preventing PHT and shivering among elderly patients undergoing abdominal or pelvic surgery. We conducted a comprehensive literature search across PubMed, EMBASE, Cochrane library, and China Wanfang databases for randomized controlled trials (RCTs) published up to April 2024. Inclusion criteria encompassed RCTs comparing warming strategies in patients aged ≥ 60 years undergoing abdominal or pelvic surgery. Methodological quality was assessed using the Cochrane Risk of Bias tool 2.0. Primary outcomes included incidence rates of PHT and shivering. A frequentist approach to NMA was performed using random-effects models, with surface under the cumulative ranking curve (SUCRA) values calculated for treatment ranking. The analysis incorporated 18 RCTs (n = 2161) evaluating eight distinct warming strategies. Network meta-analysis revealed that forced-air warming with blankets at ≥ 40 °C (FABWH) demonstrated superior efficacy for PHT prevention, while forced-air warming at ≥ 40 °C (FAWH) showed optimal performance for shivering reduction. Compared to standard care, FABWH significantly reduced PHT risk (RR = 0.14, 95% CI 0.04-0.46; P = 0.0012) and shivering incidence (RR = 0.21, 95% CI 0.07-0.69; P = 0.008). FAWH exhibited comparable effectiveness, with risk reductions of 72% for PHT (RR = 0.28, 95% CI 0.13-0.58; P = 0.0006) and 84% for shivering (RR = 0.16, 95% CI 0.07-0.39; P < 0.001). This NMA provides robust evidence that active warming strategies, particularly FABWH and FAWH, significantly mitigate PHT and shivering risks in elderly surgical patients. Future research should focus on long-term outcomes and cost-effectiveness analyses to optimize clinical decision-making.

Keywords: Abdominal or pelvic surgery; Electrically; Hypothermia; Meta-analysis; Warming strategy.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethical approval and informed consent: This study did not involve direct interaction with human subjects or collection of individual patient data, and therefore did not require ethical approval and informed consent statements.

Figures

Fig. 1
Fig. 1
Flow chart of literature screening.
Fig. 2
Fig. 2
Network relationship diagram of the impact of different heat preservation strategies on the incidence of hypothermia and shivering. (A) hypothermia; (B) shivering.
Fig. 3
Fig. 3
Network meta-analysis of the effects of different heat preservation strategies on the incidence of hypothermia and shivering. (A) Hypothermia; (B) shivering.
Fig. 4
Fig. 4
Network ranking diagram of the effects of different heat preservation strategies on the incidence of hypothermia and shivering. (A) Hypothermia; (B) shivering.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Yin, L., Wang, H., Yin, X. & Hu, X. Impact of intraoperative hypothermia on the recovery period of anesthesia in elderly patients undergoing abdominal surgery. BMC Anesthesiol.10.1186/s12871-024-02509-6 (2024). - PMC - PubMed
    1. Yin, L., Wang, H., Yin, X. & Hu, X. Impact of intraoperative hypothermia on the recovery period of anesthesia in elderly patients undergoing abdominal surgery. BMC Anesthesiol.24, 124. 10.1186/s12871-024-02509-6 (2024). - PMC - PubMed
    1. Jiang, Y. et al. Perioperative hypothermia in elderly patients during pelvic floor reconstruction surgery: An observational study. Int. Urogynecol. J.35, 1163–1170. 10.1007/s00192-024-05781-9 (2024). - PubMed
    1. Baucom, R. B. et al. Association of perioperative hypothermia during colectomy with surgical site infection. JAMA Surg.150, 570–575. 10.1001/jamasurg.2015.77 (2015). - PubMed
    1. Beilin, B. et al. Effects of mild perioperative hypothermia on cellular immune responses. Anesthesiology89, 1133–1140. 10.1097/00000542-199811000-00013 (1998). - PubMed

Publication types