Timing and methods of perioperative warming in adult surgery: A systematic review

We aimed to identify and categorise the timing and methods of warming interventions in recent literature and describe the landscape of perioperative warming practices. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, six databases were searched, targeting randomised controlled trials published between 2015 and 2025. Studies were selected using predefined inclusion and exclusion criteria to identify current practices for perioperative temperature management. Methodological quality of the included studies was evaluated. Overall, 22 studies were reviewed; 17 reported significant improvements in clinical outcomes. Active prewarming was highly effective. Multimodal strategies demonstrated superior efficacy, with a reduction in hypothermia incidence. Although multimodal approaches were effective in seven of nine studies, only four specifically involved structured procedures, such as the use of checklists. Active prewarming and multimodal approaches effectively prevent perioperative hypothermia, and having established protocols is important. Specific procedures for managing temperature perioperatively are essential for improving patient safety.