Association between intraoperative temperature management and surgical site infection in patients undergoing total hysterectomy: a retrospective analysis

Surgical site infection (SSI) is a common complication after hysterectomy, which seriously affects the prognosis of patients. Perioperative hypothermia may increase the risk of infection in patients, but its specific association in total hysterectomy is not clear. To investigate the association between intraoperative temperature management and the incidence of postoperative surgical site infection in patients undergoing hysterectomy. From September 2024 to March 2026, 136 patients who underwent hysterectomy due to benign diseases were retrospectively analyzed. Core intraoperative temperature was continuously monitored by means of an esophageal or nasopharyngeal probe. According to the lowest body temperature, the patients were divided into three groups: normothermia group (≥ 36.0 °C), mild hypothermia group (35.0–35.9 °C) and significant hypothermia group (< 35.0 °C). The primary outcome was SSI within 30 days after surgery. Multivariate Logistic regression analysis was used to evaluate the independent association between hypothermia and SSI. A restricted cubic spline model was applied to model the dose–response relationship between intraoperative body temperature, considered as a continuous variable, and the probability of SSI. The overall incidence of SSI was 9.6% (13/136). Multivariate analysis showed that intraoperative hypothermia (< 36.0 °C) was an independent risk factor for SSI (OR = 3.85, 95%CI: 1.42–10.45, P = 0.008) after adjusting for surgical approach, operation time, and history of diabetes. Dose-response analysis revealed a significant non-linear relationship between intraoperative body temperature and the risk of SSI ( P < 0.001). When body temperature was below 36.0 °C, the risk of SSI began to increase significantly. Below 35.0 °C, the risk increases sharply. The SSI risk increased by 65% (OR = 1.65, 95%CI: 1.18–2.31, P = 0.004) for every 30 min longer operation time. Intraoperative hypothermia is an independent risk factor for surgical site infection after hysterectomy, and the risk of SSI increases non-linearly with the decrease of body temperature. Maintaining an intraoperative core temperature above 36.0 °C is essential to reduce the risk of infection.