<![CDATA[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.]]>
