Inadvertent perioperative hypothermia increases susceptibility to surgical site infection (SSI) through impaired immune function, reduced oxidative killing, and altered collagen deposition. We performed a narrative review of recent clinical and translational studies evaluating active thermal management for SSI prevention, with emphasis on forced-air warming (FAW) and conductive systems, and on high-risk settings (prolonged surgery, elevated BMI, and pediatric patients). Across studies, active warming more reliably maintains intraoperative normothermia than passive insulation; however, evidence for a consistent reduction in SSI rates is strongest in vulnerable cohorts and lengthy procedures and remains heterogeneous across specialties. FAW demonstrates high warming efficiency, yet its use in implant-based operations continues to be debated because of potential airflow disruption and bacterial mobilization concerns. The literature increasingly supports precision approaches, including pre-warming protocols, improved perioperative temperature monitoring, and predictive models to identify patients at greatest risk of hypothermia. In conclusion, effective SSI prevention requires procedure- and patient-specific thermal strategies, selecting devices that balance warming performance with sterility considerations while integrating perioperative risk stratification and real-time monitoring.
Joniec et al. (Sun,) studied this question.