Exploring current practices and attitudes towards warm up for surgery

      Background: HPB surgeons are expected to perform complex surgical procedures at all times of the day and night often with little warning or chance to “warm up” beforehand. Recent evidence suggests “warming up” before operating could improve intra-operative performance with parallels to elite sporting events. We aimed to explore receptiveness, warm-up preferences, and whether strategies to warm up differ as a function of experience.
      Material & Methods: An electronic survey was distributed via training programs, specialty associations and social media. Questions concerned seniority, operative experience, use of warm-up strategies and perceptions of warm-up. Free text comments were grouped into themes for analysis.
      Results: There were 284 replies from diverse surgical specialties with 52% of replies from senior surgeons (consultants/attendings). Trainees employed various Methods to warm-up including simulation courses, laparoscopic trainers and online educational material encompassing motor and cognitive strategies. Over 80% of trainees frequently discuss steps of a procedure with a colleague compared with 45% of consultants. Trainers were more likely than their juniors to use cognitive strategies including mental rehearsal, reading technical notes, and colleague discussion. With increasing seniority warming up extended to anticipating difficulties, and discussing strategies with the surgical operating room team in preparation for periods of high cognitive stress load.
      Whilst only 45.8% felt warm up improved patient safety 72% of respondents would want their own surgeon to have warmed up if they were undergoing surgery. The work environment was identified as the biggest factor for hindering adequate preoperative mental preparation.
      Conclusions: This study represents the first examination of surgeons’ practices and attitudes towards warming-up. Approaches and definitions of activities that constitute surgical warm-up are heterogenous. Strategies appear to differ with experience and vary with case complexity. This survey indicates a need to develop formalised evidence-based approaches for warm-up that overcome identified barriers to implementation.