Head-down tilt lithotomy position and well-leg compartment syndrome: An international survey of current practice

Uzoma, C. C.; Shepherd, A. I.; Saynor, Z. L.; Khan, J. S.; Piozzi, G. N.; Duhoky, R.; Askew, C.; Ozmen, M. M.; Middleton, T. R. F.; Masum, S.; Perissiou, M.; Goswami, A. G.; Aziz, A.; Elnour, A.; Ndong, A.; Hamid, A. F. B. A.; Khan, A.; Kulfi, A. M.; Mylonakis, A.; Adeyeye, A.; Fuentes, A. L.; Mikneviciute, A.; Hassouneh, A.; El-Hussuna, A.; Aregawi, A. B.; Aiolfi, A.; Arezzo, A.; Herrando, A. I.; Vannelli, A.; Malagnino, A.; Julianov, A.; Kozadinos, A.; Theodorou, A.; Yildirim, A. C.; Guner, A.; Malik, A.; Mohamedahmed, A. Y.; Bulut, A.; Antonelli, A.; Botros, A.; Mureb, A. A.; Zakaria, A. D.; Divizia, A.; Guida, A. M.; Romanzi, A.; Gumbs, A. A.; Lynch, A. C.; Day, A.; Marra, A. A.; Parello, A.; Paspala, A.; Lin, A.; Castaldi, A.; Luberto, A.; Lagana, A. S.; Koutras, A.; Picciariello, A.; Ioannidis, A.; Papadopoulos, A.; Rashid, A.; Kerawala, A. A.; Marinis, A.; Pantelis, A.; Syllaios, A.; Acheson, A.; Saklani, A.; Oladayo, A. B.; Kobalava, B.; Hemmelova, B.; Drago, B.; Yohannes, B.; Sebastian, B.; Ratto, C.; Gianmaria, C. P.; Guldogan, C. E.; Ciubotaru, C. I.; Onyeze, C. I.; Agbo, C. A.; Bali, C.; Fleming, C.; Kontopoulou, C.; Chouliaras, C.; Benlice, C.; Tatar, C.; Akyol, C.; Coco, C.; Peirce, C.; Nastos, C.; Gallardo, C.; Huscher, C.; Wright, D.; Wilby, D.; Brogden, D.; Verdi, D.; Merlini, D.; Watt, D.; Pertile, D.; Burke, D.; Markos, D.; Sasia, D.; Ntourakis, D.; Papaconstantinou, D.; Tsapralis, D.; Korkolis, D. P.; Chrysikos, D.; Gomes, D. C.; Bowley, D.; Dardanov, D.; Thorgersen, E. B.; Ozdemir, E.; Kadhim, E. J.; Spartalis, E.; Andriopoluou, E.; Reitano, E.; Li, E.; Van Eetvelde, E.; Akpo, E.; Gonullu, E.; Gunay, E.; Tekin, E.; Harrison, E.; Yilmaz, E. M.; Sammartano, F.; Cheung, F. Y.; Huda, F.; Di Marco, F.; Aljarad, F.; Carannante, F.; Hayati, F.; Poelmann, F. B.; Decebal, F.; Dixon, F.; Bianco, F.; Pata, F.; Murillo, G. A.; Marchitelli, G.; Van Van Ramshorst, G. H.; Colletti, G.; Paramasvaran, G.; Fragulidis, G.; Rallis, G.; Stravodimos, G.; David, G.; Calini, G.; Carganico, G.; Formisano, G.; Cassese, G.; Pellino, G.; Bogani, G.; Dalmonte, G.; Lisi, G.; Cestaro, G.; Turri, G.; Brisinda, G.; Cucinella, G.; Frazzetta, G.; Martin-Martin, G. P.; Gbenga, H. O.; Karakullukcu, H. K.; Krentel, H.; Mukhtar, H.; Elmansi Abdalla, H. E.; Mangal, H. K.; Elfeki, H.; Daniels, I.; Darwich, I.; Garzali, I. U.; Egbuchulem, I. K.; Merlini, I.; Ismayilov, I.; Turan, I.; Katsaros, I.; Virlos, I.; Negoi, I.; Ahmed, I.; Andreuccetti, J.; Glasbey, J.; Olivier, J.; Wheeler, J.; Ahmed, J.; Cagas, J.; Torkington, J.; Sagar, J.; Meyer, J.; Teoh, J. Y. -C.; Mah, J. J.; Afam-Osemene, J.; Lee, J.; Bulte, J. P.; Mathew, J.; Davies, J.; Sahnan, K.; Malhotra, K.; Gunasekare, K.; Kamer, K. E.; Rida, K.; Vasileios, K. C.; Apostolou, K.; Bouchagier, K.; Kopanakis, K.; Stratakis, K.; Mikhail, K.; Jourand, K.; Khobragade, K.; Samarakoon, L. B.; Oladimeji, L. B.; Siragusa, L.; Dimitrios, L.; Victor, L. -L.; Bonomo, L. D.; Pio, L.; Taglietti, L.; Battaglia, L.; Bonavina, L.; Khan, M. M.; West, M. A.; Cannistra, M.; Catarci, M.; Giacometti, M.; Sighinolfi, M. C.; Papadoliopoulou, M.; Sotiropoulou, M.; Trompetto, M.; Kryzauskas, M.; Paraoan, M. T.; Potter, M. A.; Brincat, M. R.; Spalluto, M.; Rutegard, M.; Podda, M.; Frountzas, M.; Koc, M. A.; Ozduman, M. O.; Abdella, M. K.; Guler, M.; Spartalis, M.; Vailas, M.; Adamina, M.; Ballabio, M.; Thaha, M. A.; Sultan, M. A. H.; Ebrahim, M.; Khan, M. F.; Inamdar, M. B.; Eid, M.; Thanapal, M. R.; Azahar, M. S. M.; Andrea, M.; Shalaby, M.; Johan, M. N. S. B. C.; Shafique, M. S.; Shamim, M.; Younis, M. U.; Ergenc, M.; George, M. D.; Kalin, M.; Uzunoglu, M. Y.; Arslan, N. C.; Samalavicius, N. E.; Curtis, N.; Kumar, N.; Sang, N. T.; Wong, N.; Cinardi, N.; De'Angelis, N.; Flamey, N.; Tamini, N.; Chatzizacharias, N.; Koliakos, N.; Machairas, N.; Michalopoulos, N. V.; Eli, N.; Kiziltoprak, N.; Okkabaz, N.; Akinbami, N.; Ekwunife, O. H.; Ozkan, O. F.; Yalkin, O.; Irowa, O.; Yalav, O.; Ioannidis, O.; Milito, P.; Vassiliu, P.; Delrio, P.; Herzog, P.; Tejedor, P.; Okeny, P.; Ihnat, P.; Agbonrofo, P. I.; Vlcek, P.; Pucher, P. H.; Fransvea, P.; Naik, P.; Thambi, P.; Wichendu, P.; Mckinney, R.; Grau, R. G.; Salas, R. S.; Galleano, R.; Izquierdo, R.; Peravali, R.; Aoun, R.; Aggarwal, R.; Reid, R.; Isaacs, R.; Monteiro, R. C. C.; Campanati, R. G.; Patel, R.; Sampietro, R.; Crolla, R.; Cabantac, R. R.; Mbiine, R.; Azuaga, R. D.; Oyewale, S.; Sasi, S. P.; Balkan, S. M.; Di Saverio, S.; Stefan, S.; Aniello, S. G.; Keong, S. B.; Atici, S. D.; Subramaniam, S.; Kim, S. H.; Efetov, S.; Navarro, S. M.; Arinkan, S. A.; Leventoglu, S.; Shaikh, S.; Middleton, S.; Manfredelli, S.; Basu, S.; Christodoulou, S.; Dritsas, S.; D'Ugo, S.; Bogdan, S.; Kapiris, S.; Karn, S.; Krivan, S.; Tamas, S.; Colak, T.; Uprak, T. K.; Petropoulou, T.; Sidiropoulos, T.; Ayase, T. D.; Koeter, T.; Dominioni, T.; Fontana, T.; Violante, T.; Gwaram, U.; Ebochue, U.; Calu, V.; Munikrishnan, V.; Sud, V.; Vigorita, V.; Bellato, V.; Bresadola, V.; Aliyev, V.; Dar, W.; Khan, Z. A.; Senol, Z.; Jaddoa, Z. O.; Nikolaos, Z.; Yankai, Z.; Garoufalia, Z.; Din, Z. U.; Apollon, Z.; Anestiadou, Epsilon.; Lakshmi, H. N.; Nefeli-Kaiti, T.; Kuzu, M. A.; De Nardi, P.; Iryivuze, O.; Dhaygude, S.; Paisol, N. H. B.; Rauf, S.; Tsepov, D.; Hasan, M.; Alberts, J.; Prasannakumar, A. B.; Turu, D.; Adam, A.; Yesildal, C.; Eltyeb, H.; Baeza-Ibanez, P.; Azharuddhin, M.; Amhaimed, A.; Velez, C. A. A.; Et-Tayab, O.; Speake, W.; Kirkan, E. F.; Mishra, M.; Paraskevopoulos, I.; Picardi, B.; Mendez, B. F. R.; Bako, V.; Deryol, R.; Ayele, H. T.

doi:10.1111/codi.70134

Aim: Well-leg compartment syndrome (WLCS) is a serious complication of prolonged surgery in the head-down tilt lithotomy (HDTL) position associated with increased postoperative morbidity and mortality. However, there is a lack of awareness and clinical guidance regarding prevention of WLCS. The aim of this study was to assess current HDTL-related practices and occurrence of WLCS among a global cohort of clinicians. Method: An international online survey of clinicians was conducted between July and December 2023. Data analysis involved descriptive statistics, machine learning techniques and qualitative content analysis. Results: A total of 595 clinicians from 71 countries and 14 specialities participated. Most (98%) reported routine use of HDTL, 27% of whom did not implement any preventive strategies. ‘Leg rest’ was the most reported preventive measure (41%), commonly initiated after 2 or 3 h of HDTL (79%), for 10–15 min (56%). Overall, 170 cases of WLCS were reported by 21% of respondents. The majority reported unilateral WLCS (81%) following a laparoscopic procedure (63%) performed in HDTL (64%). Only 28% of respondents discussed WLCS during consent for operations in HDTL. Machine learning identified ‘duration of uninterrupted HDTL’ as a positive predictor of the occurrence of WLCS (p < 0.001). Content analysis demonstrated that clinician perspectives and practices regarding WLCS are significantly influenced by personal experience, mostly due to a poor evidence base and lack of standardized institutional policies. Conclusion: Perioperative practices during procedures in HDTL vary substantially, and are primarily informed by clinician experience and preferences. There is a need for evidence-based consensus on best practices to enhance safety during procedures in HDTL.