Efficacy of an Intelligent Closed-Loop Warming System in Preventing Perioperative Hypothermia and Improving Recovery in Video-Assisted Thoracoscopic Surgery: A Randomized Controlled Trial

Purpose: To evaluate the efficacy of an intelligent closed-loop warming system compared with conventional warming methods in preventing perioperative hypothermia and improving postoperative recovery in patients undergoing video-assisted thoracoscopic surgery (VATS). Patients and Methods: A total of 118 adult patients scheduled for elective VATS were randomly assigned to the conventional warming group (n = 59) or the intelligent closed-loop warming group (n = 59). Conventional warming management employed an underbody warming blanket, supplemented with blood and fluid warming when core temperature fell below 36.0°C. The intelligent closed-loop warming system utilized wireless sensors and an automated feedback-controlled warming unit to maintain core temperature between 36.5°C and 37.0°C. Core temperature was continuously monitored from anesthesia induction to post-anesthesia care unit (PACU) discharge. The primary outcome was the incidence of perioperative hypothermia (core temperature < 36.0°C). Secondary outcomes included mean and minimum intraoperative temperature, extubation time, PACU temperature, postoperative complications, length of hospital stay (HLOS), and hospitalization cost. Results: Perioperative hypothermia occurred in significantly fewer patients in the intelligent group than in the conventional group (25.4% vs. 76.3%, p < 0.001). The intelligent closed-loop warming system maintained higher mean (36.40 ± 0.33°C vs. 35.96 ± 0.45°C, p < 0.001) and minimum (36.09 ± 0.35°C vs. 35.58 ± 0.58°C, p < 0.001) core temperatures. Extubation time was shorter (5.12 ± 2.31 min vs. 9.69 ± 8.27 min, p < 0.001), PACU temperature was higher ( p = 0.001), postoperative fever incidence was lower (0% vs. 13.6%, p = 0.006), and HLOS was reduced (10.02 ± 3.87 vs. 11.63 ± 4.25 days, p = 0.034). No significant differences were observed in infection rate or hospitalization cost. Conclusion: The intelligent closed-loop warming system effectively prevents perioperative hypothermia and enhances postoperative recovery in VATS patients. It provides precise thermal regulation and better clinical outcomes, supporting its application in perioperative temperature management. Keywords: intelligent closed-loop warming, perioperative hypothermia, video-assisted thoracoscopic surgery, temperature management