THE RELATIONSHIP BETWEEN BODY MASS INDEX AND DURATION OF SURGERY WITH THE INCIDENCE OF HYPOTHERMIA IN PATIENTS FOLLOWING SPINAL ANESTHESIA: A LITERATURE REVIEW
DOI:
https://doi.org/10.61677/jth.v4i2.1121Keywords:
Body mass index, duration of surgery, hypothermia, spinal anesthesia, postoperative.Abstract
Hypothermia is a common perioperative complication in patients undergoing surgery with spinal anesthesia, resulting from disrupted thermoregulatory mechanisms caused by sympathetic blockade and heat redistribution from the body core to peripheral tissues. Body mass index (BMI) and duration of surgery are two factors frequently reported to be associated with the incidence of hypothermia following spinal anesthesia. This study aimed to synthesize national and international evidence on the association of body mass index and duration of surgery with the incidence of hypothermia in patients following spinal anesthesia through a PRISMA-based literature review. Google Scholar, PubMed, and Scopus were searched for articles published in 2021–2026, yielding 1,350 articles, of which 10 articles (5 national and 5 international) were selected based on the eligibility criteria and quality appraisal using the Critical Appraisal Skills Programme (CASP). Most included studies were observational. The synthesis showed that lower body mass index and longer duration of surgery were associated with an increased incidence of hypothermia and shivering following spinal anesthesia in most studies (p<0.05), although the observational designs do not allow causal inference. Integrating Indonesian and international evidence indicates that these associations are similar across health systems, while national evidence is still dominated by small single-site studies. In conclusion, body mass index and duration of surgery are associated factors that warrant attention from anesthesia providers and nurses for early risk identification, rigorous body temperature monitoring, and adequate perioperative thermal management.
References
Ashoobi, M. T., Shakiba, M., Keshavarzmotamed, A., & Ashraf, A. (2023). Prevalence of postoperative hypothermia in the post-anesthesia care unit. Anesthesiology and Pain Medicine, 13(5), 1-7. https://doi.org/10.5812/aapm-136730
Chaidir, R., Rustam, J., & Andriani, A. (2023). Hubungan indeks massa tubuh (IMT) dengan hipotermia pada pasien post operasi di ruang recovery room. Journal of Midwifery and Healthcare Sciences, 1(1), 1–7. https://journal.umnyarsi.ac.id/index.php/JMHS/article/view/4
Ferede, Y. A., Aytolign, H. A., & Mersha, A. T. (2021). “The magnitude and associated factors of intraoperative shivering after cesarean section delivery under spinal anesthesia”: A cross sectional study. Annals of Medicine and Surgery, 72, 1-5. https://doi.org/10.1016/j.amsu.2021.103022
Hu, Z., Li, W., Liang, C., & Li, K. (2023). Risk factors and prediction model for inadvertent intraoperative hypothermia in patients undergoing robotic surgery: A retrospective analysis. Scientific Reports, 13, 1-7. https://doi.org/10.1038/s41598-023-30819-1
Kanchan, S., Shah, A. M., Shah, A., Sameen, Z., Arya, A., Riaz, S., Zaman, M., & Santapur, M. (2022). Post spinal anaesthesia shivering: Incidence and associated risk factors in patients undergoing lower limb and abdominal surgeries. International Journal of Research in Medical Sciences, 10(10), 2285–2290. https://doi.org/10.18203/2320-6012.ijrms20222536
Mashak, B., Mafakheri, A., Dashtkoohi, M., Pourbahrighesmat, S., Zareie, D., Hatamian, S., Arman, M., Rezaeinejad, M., & Ghaemi, M. (2026). Association between body mass index and perioperative shivering after elective cesarean delivery under spinal anesthesia: A prospective observational study. BMC Anesthesiology, 26(1), 1-9. https://doi.org/10.1186/s12871-025-03517-w
Muntaha, Y., Sumarni, T., & Ma’rifah, A. R. (2022). Hubungan indeks massa tubuh dan lama operasi dengan kejadian hipotermia pada pasien post operasi dengan anestesi spinal di RSU Metro Medical Center Lhokseumawe. Prosiding Seminar Nasional Penelitian dan Pengabdian kepada Masyarakat, 2(1), 537–544. https://doi.org/10.35960/snppkm.v2i1.1118
Rakasiwi, M. R., Hastusi, W., & Nurprastina, G. (2021). Pengaruh indeks massa tubuh dengan kejadian hipotermi pada pasien anestesi spinal. Jurnal Sains dan Kesehatan (JUSIKA), 5(2), 129–137. https://doi.org/10.57214/jusika.v5i2.638
Rauch, S., Miller, C., Bräuer, A., Wallner, B., Bock, M., & Paal, P. (2021). Perioperative hypothermia—A narrative review. International Journal of Environmental Research and Public Health, 18(16), 1-15. https://doi.org/10.3390/ijerph18168749
Renaningtyastutik, Y., Lumadi, S. A., & Handian, F. I. (2022). The relationship between operation duration and shivering in post-spinal anaesthesia patients. The Journal of Palembang Nursing Studies, 1(3), 107–114. https://doi.org/10.55048/jpns.v1i3.29
Sahin Akboga, O., & Dikmen Aydin, Y. (2024). Barriers and solutions in implementing evidence-based recommendations to prevent intraoperative inadvertent hypothermia: A qualitative study. Therapeutic Hypothermia and Temperature Management, 14(4), 282–289. https://doi.org/10.1089/ther.2023.0052
Tan, R., Chen, Y., Yang, D., Long, X., Ma, H., & Yang, C. (2025). Risk factors for postoperative hypothermia in non-cardiac surgery patients: A systematic review and meta-analysis. BMC Anesthesiology, 25(1), 1-10. https://doi.org/10.1186/s12871-025-03089-9
Thaher, M. J., Novitasari, D., & Suryani, R. L. (2024). Hubungan indeks massa tubuh dengan kejadian hipotermia pasca anestesi umum. Jurnal Penelitian Perawat Profesional, 6(2), 867–874. https://doi.org/10.37287/jppp.v6i2.2308
Tubalawony, S. L., & Siahaya, A. (2023). Pengaruh anestesi spinal terhadap kejadian hipotermi pada pasien post operasi. Jurnal Keperawatan, 15(1), 331–338. https://doi.org/10.32583/keperawatan.v15i1.836
Wan, J.-X., Li, X.-C., Zeng, S.-S., Li, Y.-Q., & Wang, F.-J. (2023). Comparison of intravenous butorphanol vs. tramadol for post-spinal anesthesia shivering: A meta-analysis and systematic review. Frontiers in Medicine, 10, 1-10. https://doi.org/10.3389/fmed.2023.1271664
Wang, X., Zhang, Y., Li, Z., Wang, X., & Qiu, H. (2024). Risk factors for perioperative hypothermia in pregnant women undergoing cesarean section: A systematic review and meta-analysis. Annali Italiani di Chirurgia, 95(4), 448–460. https://doi.org/10.62713/aic.3337
Wongyingsinn, M., & Pookprayoon, V. (2023). Incidence and associated factors of perioperative hypothermia in adult patients at a university-based, tertiary care hospital in Thailand. BMC Anesthesiology, 23(1), 1-10. https://doi.org/10.1186/s12871-023-02084-2
Woretaw, A. W., Mekonnen, B. Y., Tsegaye, N., & Dellie, E. (2023). Knowledge and practice of nurses with respect to perioperative hypothermia prevention in the Northwest Amhara Regional State referral hospitals, Ethiopia: A cross-sectional study. BMJ Open, 13(12), 1-11. https://doi.org/10.1136/bmjopen-2022-068131
Xu, R., Hu, X., Sun, Z., Zhu, X., & Tang, Y. (2023). Incidence of postoperative hypothermia and shivering and risk factors in patients undergoing malignant tumor surgery: A retrospective study. BMC Anesthesiology, 23(1), 1-11. https://doi.org/10.1186/s12871-023-01991-8
Zhou, H., Li, L., Li, Q., Guo, X., Xu, N., Zheng, Q., & Fu, Q. (2025). The warming management measures may need to be further enhanced during scoliosis correction and internal fixation surgery: A retrospective cohort study. Therapeutic Hypothermia and Temperature Management, 15(3), 124–133. https://doi.org/10.1089/ther.2024.0041
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