Preventing unplanned perioperative hypothermia is crucial. Thermal reflective blankets may reduce heat loss, promote normothermia, increase patient comfort, and decrease cotton blanket expenses. Our purpose was to determine whether a thermal reflective blanket plus one warmed cotton blanket provides better temperature control and thermal comfort than warmed cotton blankets only. We compared two groups of perioperative patients who received a thermal reflective blanket plus one warmed cotton blanket (n = 110) or warmed cotton blankets only (n = 114) for temperature control and comfort, and we evaluated outcomes in the preoperative holding area, the OR, and the postanesthesia care unit. There were no significant differences in patient temperature or comfort between groups. Use of thermal reflective blankets led to significantly reduced use of warmed cotton blankets (t209 = -10.51, P < .001), and a cost threshold for clinical adoption was identified. The hospital opted not to purchase thermal reflective blankets because of equivalent performance and minimal cost savings.