Intraoperative hypothermia in children undergoing extremity fracture surgery: incidence, risk factors, predictive model, and clinical implications

Intraoperative hypothermia is a common perioperative complication in pediatric orthopedic surgeries. This study aimed to investigate the incidence, independent risk factors of intraoperative hypothermia in children undergoing extremity fracture surgery, construct a predictive model, and propose targeted nursing countermeasures. A retrospective study was conducted on children who underwent extremity fracture surgery in of our hospital from August 2023 to August 2025. Univariate correlation analysis and multivariate logistic regression were used to identify independent risk factors. A scoring-based predictive model was constructed, and its performance was evaluated by receiver operating characteristic (ROC) curve analysis. A total of 266 children with limb fractures were included. The incidence of intraoperative hypothermia was 18.0% (48/266). Multivariate logistic regression analysis showed that age ≤ 7 years (OR = 3.258, 95%CI:2.125 ~ 4.369), BMI ≤ 17 kg/m² (OR = 2.986, 95%CI:1.856 ~ 4.023), operation duration ≥ 90 min (OR = 4.528, 95%CI:3.256 ~ 5.823), intraoperative blood loss > 100 ml (OR = 5.286, 95%CI:3.852 ~ 6.758), and use of unheated irrigation fluid (OR = 6.125, 95%CI:4.325 ~ 7.923) were independent risk factors (all P < 0.001). The predictive model constructed with these factors had a total score range of 0 to 10 points. Using an achievable cutoff of ≥ 6 points, the sensitivity was 81.3% and specificity 78.6%; at a cutoff of ≥ 8 points, sensitivity was 62.5% and specificity 92.8%. The area under the ROC curve (AUC) was 0.876 (95%CI:0.823 ~ 0.929, P < 0.001). Intraoperative hypothermia occurs in 18.0% of children undergoing extremity fracture surgery. The identified independent risk factors—age ≤ 7 years, BMI ≤ 17 kg/m², operation duration ≥ 90 min, blood loss > 100 ml, and unheated irrigation fluid—enable preoperative risk stratification using a simple 10-point scoring system (AUC = 0.876). These findings support the implementation of targeted nursing interventions, including preoperative risk assessment, routine use of warming blankets, heated irrigation fluids, and standardized temperature monitoring protocols for high-risk children.