Perioperative Outcomes Associated with Intraoperative Hypothermia in Pediatric Patients with Preserved Functional Capacity Undergoing Anesthesia: A Multivariate Analysis
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design and Ethical Approval
2.2. Standard Operating Procedures for Pediatric Anesthesia
2.3. Main Exposure
2.4. Potential Confounding Variables
2.5. Definition of Variables
2.6. Outcomes
2.7. Sample Size Determination
2.8. Statistical Analysis
3. Results
3.1. Patient Baseline Characteristics
3.2. Hypothermia-Related Outcomes
3.3. Univariate and Multivariate Logistic Regression Analysis of Significant Outcomes Related to Intraoperative Hypothermia
3.4. Univariate and Multivariate Negative Binomial Regression Analysis of Duration of Ventilator Requirement and ICU Stay, Related to Intraoperative Hypothermia
3.5. Univariate and Multivariate Linear Regression Analysis of the Logarithm of Hospitalization Duration Related to Intraoperative Hypothermia
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
AR | Allergic rhinitis |
ASA | American Society of Anesthesiologists |
BSA | Body surface area |
CI | Confidence interval |
GA | General anesthesia |
ICU | Intensive care unit |
IQR | Interquartile range |
OR | Odds ratio |
PACU | Post-anesthesia care unit |
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Variable | Intraoperative Hypothermia | p-Value | |
---|---|---|---|
No (n = 723) | Yes (n = 169) | ||
Demographics | |||
Male sex | 468 (64.7%) | 108 (63.9%) | 0.8 |
Age (years), median (IQR) | 4.6 [1.8, 7.7] | 3.9 [1.2, 8.1] | 0.12 |
Age (years) ≥1/<1 | 619 (85.6%)/104 (14.4%) | 129 (76.3%)/40 (23.7%) | 0.003 * |
Body weight (kg), median (IQR) | 15.6 [10.2, 22.8] | 14.6 [9.0, 23.0] | 0.06 |
Body height (cm), median (IQR) | 102.0 [80.3, 122.0] | 99.0 [72.0, 122.0] | 0.12 |
Percentile weight >P3/≤P3 | 578 (79.9%)/145 (20.1%) | 126 (74.6%)/43 (25.4%) | 0.12 |
BSA (m2), median (IQR) | 0.7 [0.5, 0.9] | 0.6 [0.4, 0.9] | 0.05 |
Weight-to-BSA ratio, median (IQR) | 23.5 [21.1, 26.6] | 23.2 [20.4, 25.6] | 0.087 |
Underlying disease | |||
Cardiovascular disease | 123 (17.0%) | 26 (15.4%) | 0.6 |
Respiratory disease | 129 (17.8%) | 32 (18.9%) | 0.7 |
Neurologic disease | 60 (8.3%) | 30 (17.8%) | <0.001 * |
Hematologic disease | 220 (30.4%) | 55 (32.5%) | 0.6 |
Endocrine disease | 46 (6.4%) | 9 (5.3%) | 0.6 |
Elective/emergency surgery | 628 (86.9%)/95 (13.1%) | 151 (89.3%)/18 (10.7%) | 0.4 |
Preoperative body temperature (°C), median (IQR) | 36.8 [36.6, 37.0] | 36.8 [36.6, 37.0] | 0.5 |
Route of temperature monitoring | 0.11 | ||
Rectal | 69 (9.6%) | 14 (8.4%) | |
Nasopharyngeal | 160 (22.2%) | 48 (28.7%) | |
Esophageal | 250 (34.7%) | 54 (32.3%) | |
Skin/axillary | 237 (32.9%) | 47 (28.1%) | |
Tympanic membrane | 5 (0.7%) | 4 (2.4%) | |
Unknown | 2 (0.3%) | 2 (1.2%) | |
Magnitude of surgery | <0.001 * | ||
Major | 50 (6.9%) | 30 (17.8%) | |
Intermediate | 510 (70.5%) | 121 (71.6%) | |
Minor | 163 (22.5%) | 18 (10.7%) | |
Site of surgery | 0.001 * | ||
Superficial | 116 (16.0%) | 19 (11.2%) | |
Eye, ear/nose/throat | 318 (44.0%) | 50 (29.6%) | |
Abdomen | 125 (17.3%) | 38 (22.5%) | |
Extremities | 133 (18.4%) | 45 (26.6%) | |
Intracranial | 17 (2.4%) | 12 (7.1%) | |
Intrathoracic | 14 (1.9%) | 5 (3.0%) |
Variable | Intraoperative Hypothermia | p-Value | |
---|---|---|---|
No (n = 723) | Yes (n = 169) | ||
ASA physical status | 0.005 ** | ||
1 | 158 (21.9%) | 39 (23.1%) | |
2 | 377 (52.1%) | 67 (39.6%) | |
3 | 188 (26.0%) | 63 (37.3%) | |
Type of GA | |||
GA with caudal/epidural block | 80 (11.1%) | 27 (16.0%) | 0.077 |
GA with peripheral nerve block | 52 (7.2%) | 18 (10.7%) | 0.13 |
Type of airway management | 0.2 | ||
Endotracheal tube | 622 (86.0%) | 139 (82.2%) | |
Laryngeal mask airway | 101 (14.0%) | 30 (17.8%) | |
Anesthesia time (min), median (IQR) | 105.0 [80.0, 150.0] | 145.0 [100.0, 190.0] | <0.001 * |
Operation time (min), median (IQR) | 70.0 [50.0, 110.0] | 100.0 [60.0, 140.0] | 0.001 * |
Neuromuscular blocking agent use | 0.023 *** | ||
None | 127 (17.6%) | 34 (20.1%) | |
Cisatracurium | 595 (82.3%) | 132 (78.1%) | |
Rocuronium | 1 (0.1%) | 3 (1.8%) | |
Volatile anesthetic use | 0.019 *** | ||
None (intravenous anesthetics only) | 21 (2.9%) | 1 (0.6%) | |
Sevoflurane | 676 (93.5%) | 167 (98.8%) | |
Desflurane | 26 (3.6%) | 1 (0.6%) | |
Active warming | 709 (98.1%) | 163 (96.4%) | 0.2 |
Fluid use | |||
Crystalloid (mL), median (IQR) | 172.0 [100.0, 300.0] | 163.0 [85.0, 350.0] | 0.8 |
Colloid | 7 (1.0%) | 2 (1.2%) | 0.7 |
Blood loss (mL), median (IQR) | 5.0 [1.0, 15.0] | 5.0 [2.0, 20.0] | 0.011 * |
Blood transfusion | 34 (4.7%) | 25 (14.8%) | <0.001 ** |
Intraoperative bradycardia | 24 (3.3%) | 5 (3.0%) | 0.5 |
Characteristic | Hypothermia Group |
---|---|
Nadir temperature (°C) | |
Mean (SD) | 35.5 (0.3) |
Median (IQR) | 35.6 [35.3, 35.7] |
Duration of hypothermia (min) | |
Mean (SD) | 65.0 (48.6) |
Median (IQR) | 60.0 (30.0, 90.0) |
Severity of hypothermia | |
Mild (34 °C to <36 °C) | 169 (100%) |
Moderate (32 °C to <34 °C) | 0 |
Variable | Intraoperative Hypothermia | p-Value | |
---|---|---|---|
No (n = 723) | Yes (n = 169) | ||
Length of PACU stay (min), median (IQR) | 45.0 [35.00, 60.0] | 45.0 [30.00, 60.0] | 0.12 |
Shivering | 6 (0.8%) | 2 (1.2%) | 0.7 |
Nausea/vomiting | 8 (1.1%) | 2 (1.2%) | 0.9 |
Postoperative oxygen requirements | 38 (5.3%) | 5 (3.0%) | 0.29 |
Oxygen cannula | 7 (1.0%) | 0 (0.0%) | 0.4 |
Non-rebreather mask | 2 (0.3%) | 1 (0.6%) | 0.2 |
Mask/oxygen flow | 28 (3.9%) | 3 (1.8%) | 0.3 |
Oxygen box | 0 (0%) | 0 (0%) | |
High-frequency nasal cannula | 1 (0.1%) | 1 (0.6%) | 0.5 |
Postoperative ventilator requirement | 78 (10.8%) | 44 (26.0%) | <0.001 ** |
Duration of oxygen and ventilator requirement (days) | |||
Mean (SD) | 1.1 (6.9) | 2.4 (7.4) | <0.001 *** |
Median (IQR) | 0.0 [0.0, 0.0] | 0.0 [0.0, 1.0] | <0.001 * |
Postoperative ICU admission | 93 (12.9%) | 51 (30.2%) | <0.001 ** |
Duration of ICU admission (days) | |||
Mean (SD) | 1.7 (8.6) | 3.4 (10.1) | <0.001 *** |
Median (IQR) | 0.0 [0.0, 0.0] | 0.0 [0.0, 1.0] | <0.001 * |
Duration of hospitalization (days) | |||
Mean (SD) | 6.6 (14.1) | 14.2 (24.5) | <0.00 1 *** |
Median (IQR) | 2.0 [1.0, 5.0] | 4.0 [2.0, 13.0] | <0.001 * |
Reintubation | 1 (0.1%) | 2 (1.2%) | 0.094 |
Variable | Postoperative Ventilator Requirement | Postoperative ICU Admission | ||
---|---|---|---|---|
Adjusted OR (95% CI) | p-Value | Adjusted OR (95% CI) | p-Value | |
Hypothermia | 1.69 (0.72, 4.01) | 0.233 | 1.52 (0.75, 3.05) | 0.248 |
Age < 1 year (Ref: ≥1) | 6.80 (2.07, 22.3) | 0.001 | 6.11 (2.36, 15.8) | <0.001 |
Respiratory tract infection/AR/asthma | 9.70 (3.55, 26.5) | <0.001 | 4.46 (2.19, 9.07) | <0.001 |
Underlying neurologic disease | 6.41 (2.43, 16.9) | 0.001 | 4.14 (1.94, 8.85) | <0.001 |
ASA physical status = 3 (Ref: ≤2) | 26.2 (9.16, 75.0) | <0.001 | 9.60 (5.07, 18.2) | <0.001 |
Body weight (kg) | 0.92 (0.86, 0.98) | 0.001 | ||
Body height (cm) | 0.98 (0.97, 0.99) | <0.001 | ||
Percentile weight ≤ P3 (Ref: >P3) | 0.35 (0.13, 0.98) | 0.039 | ||
Weight-to-BSA ratio < 16 (Ref: ≥16) | 80.0 (15.5, 414.2) | <0.001 | 11.8 (3.83, 36.3) | <0.001 |
Major surgery | 6.17 (2.14, 17.8) | <0.001 | 9.83 (4.35, 22.2) | <0.001 |
Anesthesia time (min) | 1.004 (1.0003, 1.009) | 0.03 | 1.005 (1.001, 1.009) | 0.012 |
Emergency surgery | 4.11 (1.52, 11.1) | 0.005 | ||
Intraoperative crystalloid (mL) | 1.002 (1.00, 1.003) | 0.051 | ||
Blood transfusion (mL) | 1.004 (1.00, 1.009) | 0.058 |
Variable | Duration of Ventilator Requirement (Days) | Duration of ICU Stay (Days) | Duration of Hospitalization ¶ (Days) | |||
---|---|---|---|---|---|---|
Adjusted β (95% CI) | p-Value | Adjusted β (95% CI) | p-Value | Adjusted Count Ratio (95% CI) | p-Value | |
Hypothermia | 0.15 (−0.35, 0.66) | 1 | 0.98 (0.47, 1.48) | 0.001 | 1.20 (1.04, 1.36) | 0.02 |
Age < 1 year (Ref: ≥1) | 2.18 (1.39, 2.96) | 0.001 | 2.56 (1.96, 3.16) | 0.001 | 1.82 (1.57, 2.07) | <0.001 |
Respiratory tract infection/AR/asthma | 1.02 (0.55, 1.50) | 0.001 | 1.11 (0.60, 1.61) | 0.001 | 1.16 (1.02, 1.52) | 0.04 |
Congenital heart disease | 0.36 (−0.22, 0.94) | 1 | ||||
Underlying neurologic disease | 2.06 (1.37, 2.75) | 0.001 | 2.05 (1.46, 2.64) | 0.001 | 1.27 (1.01, 1.52) | 0.069 |
Underlying hematologic disease | 1.22 (1.11, 1.34) | 0.002 | ||||
ASA physical status = 3 (Ref: ≤2) | 2.41 (1.85, 2.97) | 0.001 | 3.15 (2.66, 3.64) | 0.001 | 1.51 (1.33, 1.69) | <0.001 |
Body height (cm) | −0.015 (−0.031, 0.00) | 0.05 | 1.003 (1.000, 1.006) | 0.048 | ||
Body weight (kg) | 0.03 (−0.002, 0.058) | 0.1 | ||||
Weight-to-BSA ratio < 16 (Ref: ≥16) | 1.35 (0.59, 2.10) | 0.01 | 0.73 (−0.027, 1.50) | 0.1 | 1.30 (0.95, 1.65) | 0.146 |
Emergency surgery | 0.63 (0.073, 1.18) | 0.05 | 0.58 (−0.003, 1.16) | 0.1 | 1.34 (1.14, 1.54) | 0.005 |
Major surgery | 1.31 (0.74, 1.89) | 0.001 | ||||
Anesthesia time (min) | 1.001 (1.0006, 1.002) | 0.019 | ||||
Site of surgery (Ref: superficial) | 0.01 * | 0.001 * | ||||
Eye, ear/nose/throat | −0.74 (−1.45, 0.04) | 0.05 | 0.85 (0.64, 1.06) | 0.123 | ||
Abdomen | −1.25 (−2.01, −0.49) | 0.01 | 1.37 (1.23, 1.69) | 0.013 | ||
Extremities | −1.03 (−1.86, −0.19) | 0.05 | 1.46 (1.28, 1.76) | 0.001 | ||
Intracranial | −1.77 (−2.87, −0.66) | 0.01 | 1.41 (0.99, 1.83) | 0.1 | ||
Intrathoracic | 0.19 (−0.86, 1.24) | 1 | 2.74 (2.29, 3.19) | <0.001 | ||
Intraoperative crystalloid use (mL) | 0.002 (0.000, 0.003) | 0.01 | 1.0003 (0.999, 1.001) | 0.09 | ||
Estimate blood loss (mL) | 0.002 (0.000, 0.004) | 0.05 |
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Saezhang, W.; Oofuvong, M.; Kovitwanawong, N.; Yongyukantorn, K. Perioperative Outcomes Associated with Intraoperative Hypothermia in Pediatric Patients with Preserved Functional Capacity Undergoing Anesthesia: A Multivariate Analysis. J. Clin. Med. 2025, 14, 7320. https://doi.org/10.3390/jcm14207320
Saezhang W, Oofuvong M, Kovitwanawong N, Yongyukantorn K. Perioperative Outcomes Associated with Intraoperative Hypothermia in Pediatric Patients with Preserved Functional Capacity Undergoing Anesthesia: A Multivariate Analysis. Journal of Clinical Medicine. 2025; 14(20):7320. https://doi.org/10.3390/jcm14207320
Chicago/Turabian StyleSaezhang, Worachet, Maliwan Oofuvong, Nalinee Kovitwanawong, and Kanlayanee Yongyukantorn. 2025. "Perioperative Outcomes Associated with Intraoperative Hypothermia in Pediatric Patients with Preserved Functional Capacity Undergoing Anesthesia: A Multivariate Analysis" Journal of Clinical Medicine 14, no. 20: 7320. https://doi.org/10.3390/jcm14207320
APA StyleSaezhang, W., Oofuvong, M., Kovitwanawong, N., & Yongyukantorn, K. (2025). Perioperative Outcomes Associated with Intraoperative Hypothermia in Pediatric Patients with Preserved Functional Capacity Undergoing Anesthesia: A Multivariate Analysis. Journal of Clinical Medicine, 14(20), 7320. https://doi.org/10.3390/jcm14207320