Risk factors and predictive modeling of intraoperative hypothermia in laparoscopic surgery patients

Inadvertent intra-operative hypothermia (< 36 °C) is frequent during laparoscopic surgery and worsens postoperative outcomes. Reliable risk-prediction tools for this setting are still lacking. We retrospectively analysed 207 adults who underwent laparoscopic procedures at a single hospital (June 2021 – June 2024). Core temperature was recorded nasopharyngeally every 15 min. Hypothermia was defined as any intra-operative value < 36 °C. Univariable tests and multivariable logistic regression identified independent predictors; coefficients were converted into a weighted risk score. Model discrimination (AUC) and calibration (Hosmer–Lemeshow test, calibration plot) were assessed with 1 000-bootstrap internal validation. Hypothermia occurred in 110 patients (53%). Five variables remained independently associated with risk: body-mass index ≤ 23 kg m⁻², baseline core temperature ≤ 36.1 °C, operating-room temperature ≤ 22 °C, surgical duration ≥ 120 min, and pre-operative systolic blood pressure > 130 mmHg (all P < 0.05). The resulting five-item score (0–12 points) showed good discrimination (optimism-corrected AUC 0.80, 95% CI 0.74–0.87) and adequate calibration (Hosmer–Lemeshow P = 0.10; Brier = 0.18). A cut-off ≥ 3 points identified high-risk patients with 68% sensitivity and 90% specificity. Low BMI, low baseline temperature, cool theatre environment, prolonged surgery and hypertension jointly heighten hypothermia risk during laparoscopy. The simple five-item score enables rapid pre-operative stratification and may guide targeted warming strategies. External multicentre validation is warranted.