Effects of different intraoperative warming strategies on hypothermia and postoperative coagulation function in severely injured emergency surgery patients

Objective To compare the effects of routine and enhanced intraoperative warming strategies on perioperative hypothermia, coagulation function, and length of hospital stay in severely injured emergency surgery patients. Methods A retrospective cohort study was conducted on 134 severely injured emergency surgery patients (January 2023–December 2024), divided into a routine warming group ( n = 87) and an enhanced warming group ( n = 47). The primary outcome was hypothermia incidence at 1 h postoperative (T3), defined as core body temperature < 36.0 °C. Secondary outcomes included activated partial thromboplastin time (APTT) and prothrombin time percentage (PT%) at 12–24 h postoperative (C3), and length of hospital stay. Core body temperature was monitored at preoperative (T1), end of surgery (T2), and T3. Coagulation parameters were measured at 1 h preoperative (C1), 2–3 h postoperative (C2), and C3. Multivariable regression analyses adjusted for age, sex, injury severity score, operative duration, intraoperative blood loss, and red blood cell transfusion volume. Results Baseline characteristics were comparable between groups (all p > 0.05). The enhanced warming group had significantly higher core body temperature at T2 and T3 ( p < 0.05), with a lower hypothermia incidence at T3 ( p < 0.05). After multivariable adjustment, enhanced warming remained independently associated with reduced hypothermia risk at T3 (adjusted OR = 0.37, 95% CI 0.16–0.84, p = 0.018) and lower APTT at C3 ( β = −4.62, p = 0.033), while the PT% difference did not retain significance after adjustment ( p = 0.076). Fibrinogen was significantly lower in the enhanced warming group at all time points including baseline, indicating a pre-existing difference unrelated to the intervention. The enhanced warming group had a significantly shorter length of hospital stay after adjustment ( β = −3.42 days, p = 0.036). Conclusion Enhanced intraoperative warming was associated with lower postoperative hypothermia incidence, reduced APTT, and shorter hospital stay after confounder adjustment. Prospective trials with baseline coagulation stratification are needed to confirm these findings.