Association between intraoperative hypothermia and total hospitalization cost after liver transplantation: a retrospective cohort study

BACKGROUND: Intraoperative hypothermia is common during major surgery, but its economic implications in liver transplantation remain unclear. This study evaluated the association between intraoperative hypothermia and total hospitalization cost in adult liver transplant recipients. METHODS: This single-center retrospective cohort study included adult liver transplant recipients who underwent transplantation between January 2020 and December 2025. Intraoperative hypothermia was defined as any recorded intraoperative core temperature < 36.0 °C. Multivariable linear regression with log-transformed total hospitalization cost was used to evaluate the association after adjustment for prespecified covariates. Sensitivity analyses used additional adjustment models and alternative temperature exposure metrics. Cost components were analyzed descriptively. RESULTS: Among 343 recipients, 239 (69.68%) experienced intraoperative hypothermia. Median total hospitalization cost was higher in the hypothermia group than in the normothermia group (161,173.00 [127,519.50-218,826.50] vs. 120,691.00 [104,492.25-150,064.00] Chinese yuan (CNY); P < 0.001). After multivariable adjustment, intraoperative hypothermia remained associated with higher log-transformed total hospitalization cost (β, 0.153; 95% CI, 0.065 to 0.241; P < 0.001), corresponding to an approximately 16.6% higher cost. The association remained robust in additional adjustment models, although alternative temperature exposure metrics did not show a consistent dose-response pattern. Cost-component analysis suggested that the cost difference was mainly attributable to medication, laboratory, treatment, material, and blood transfusion costs. CONCLUSIONS: Intraoperative hypothermia was associated with higher total hospitalization cost following liver transplantation after adjustment for prespecified covariates. These findings suggest that intraoperative hypothermia may be a marker of increased perioperative resource use. Prospective studies are needed to clarify whether targeted temperature management can improve clinical outcomes and resource utilization in liver transplantation.