Intraoperative Hypothermia in Plastic Surgery: Procedure-Specific Patterns and the Call for Preventive Strategies

Introduction: Intraoperative hypothermia is a common yet underrecognized concern in plastic surgery, contributing to increased risks of surgical site infections, coagulopathy, and delayed recovery. This study characterizes intraoperative temperature dynamics and identifies procedure-specific risks to guide warming strategies. Methods: We performed a retrospective review of 1923 elective plastic and reconstructive surgeries under general anesthesia at a single academic institution. Preincision and postoperative core temperatures were recorded using nasopharyngeal or esophageal monitoring. Intraoperative temperature change was defined as the difference between these measurements. Multivariable linear and logistic regression models assessed associations between procedure type and both temperature change and postoperative hypothermia (<36.0 °C), adjusting for surgery duration, inpatient status, and preincision temperature. Results: The mean intraoperative temperature change across all procedures was +0.16 °C. However, substantial variation existed by procedure. Free flap breast reconstruction, facial procedures, oncoplastic breast reduction, and panniculectomy were associated with temperature increases, while hand surgery showed significant decreases ( P = .002). Preincision hypothermia was present in 36.6% of cases and postoperative hypothermia in 32.3%. On multivariable analysis, body contouring (OR = 1.84, P = .005) and hand procedures (OR = 3.91, P = .004) were significantly associated with increased odds of postoperative hypothermia, while aesthetic breast revision trended toward significance (OR = 1.84, P = .055). Neither surgery duration nor inpatient status predicted postoperative hypothermia. Conclusions: Hypothermia remains highly prevalent in plastic surgery procedures performed under general anesthesia, particularly among patients undergoing hand and body contouring procedures. High rates of preincision hypothermia further underscore the need for improved perioperative warming protocols. Multimodal warming strategies should be implemented consistently to maintain normothermia and reduce the risk of hypothermia-related complications.