Cerebral infarction and cerebrovascular stenosis: potential risk factors for intraoperative hypothermia in elderly patients undergoing video-assisted thoracic surgery

Abstract Intraoperative hypothermia increases the risk of various perioperative complications and delays postoperative recovery. Elderly patients exhibit impaired thermoregulatory capacity, yet the risk factors for hypothermia during video-assisted thoracic surgery still remain unclear. A retrospective analysis was conducted on patients aged ≥ 65 years who underwent video-assisted thoracic surgery at Xuanwu Hospital, Capital Medical University, from January 1, 2024, to October 1, 2025. Data on patient characteristics, preoperative and postoperative assessments, and intraoperative parameters were extracted from electronic record system and anesthesia records. A total of 401 patients were included, with an overall incidence of intraoperative hypothermia of 60.8%. Multivariate analysis identified cerebral infarction history (OR = 3.054, 95% CI 1.434–6.504, P = 0.004) and moderate to severe cerebrovascular stenosis (OR = 4.701, 95% CI 1.746–12.657, P = 0.002) as independent risk factors. Preoperative arrhythmia (OR = 2.653, 95% CI 1.501–4.691, P < 0.001) was associated with an increased risk of inadvertent hypothermia. Higher body mass index (BMI) was identified as a protective factor against hypothermia (OR = 0.928, 95% CI 0.872–0.988, P = 0.02). Intraoperative hypothermia leads to an increased incidence of postoperative pulmonary complications ( P < 0.001). The mean hospital stay was longer in the hypothermia group compared to the none-hypothermia group (9 vs. 8 days, P = 0.011). The findings indicate that preoperative cerebral infarction, moderate to severe cerebrovascular stenosis and arrhythmia may increase the risk of intraoperative hypothermia. For such high risk patients, targeted enhanced warming measures should be prioritized to reduce the incidence of this complication.