Uzoma Chukwuemeka C, Shepherd Anthony I, Saynor Zoe L, Khan Jim S, Piozzi Guglielmo Niccolò, Duhoky Rauand, Askew Christopher, Ozmen M Mahir, Middleton Thierry R F, Masum Shamsul, Perissiou Maria
Clinical Health and Rehabilitation Team, School of Psychology, Sport and Health Sciences, University of Portsmouth, Portsmouth, UK.
Department of Faculty Surgery, RUDN University, Moscow, Russia.
Colorectal Dis. 2025 Jun;27(6):e70134. doi: 10.1111/codi.70134.
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.
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.
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.
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.
健侧小腿骨筋膜室综合征（WLCS）是长时间头低脚高位截石位（HDTL）手术的严重并发症，与术后发病率和死亡率增加相关。然而，对于WLCS的预防缺乏认识和临床指导。本研究的目的是评估全球临床医生队列中当前与HDTL相关的操作及WLCS的发生情况。
2023年7月至12月对临床医生进行了一项国际在线调查。数据分析包括描述性统计、机器学习技术和定性内容分析。
共有来自71个国家和14个专业的595名临床医生参与。大多数（98%）报告常规使用HDTL，其中27%未实施任何预防策略。“腿部支撑”是最常报告的预防措施（41%），通常在HDTL 2或3小时后开始（79%），持续10 - 15分钟（56%）。总体而言，21%的受访者报告了170例WLCS病例。大多数报告为单侧WLCS（81%），发生于HDTL下进行的腹腔镜手术（63%）后（64%）。只有28%的受访者在HDTL手术同意过程中讨论了WLCS。机器学习确定“连续HDTL持续时间”是WLCS发生的阳性预测因素（p < 0.001）。内容分析表明，临床医生对WLCS的观点和操作受到个人经验的显著影响，主要原因是证据基础薄弱和缺乏标准化的机构政策。
HDTL手术期间的围手术期操作差异很大，主要受临床医生经验和偏好的影响。需要就最佳实践达成基于证据的共识，以提高HDTL手术期间的安全性。
