Research / Monday, 16 April, 2018

Surgeon performance benefits from ‘warm-up’



New research suggests that surgeons progressively ‘warm-up’ as they repeat a procedure on their operating list, the same way an athlete’s performance improves as a competition goes on. The authors of the study recommend that surgeons re-order their operating lists, beginning with simpler procedures and then increasing difficulty. They would also benefit from grouping similar cases together so they are repeatedly performing the same procedure. Doing so, according to the research from the University of Leeds, Leeds Teaching Hospitals NHS Trust and Spire Healthcare, would result in surgeons completing operations more quickly, reducing costly theatre time and potentially improving patient outcomes.


The study was based on an analysis of the records of more than a quarter of a million operations carried out at 38 UK hospitals run by a private healthcare company over two years. Previous studies have suggested operation times would get shorter as surgeons repeated a technique but these had been based on simulations not real-life practice. The research team used the hospital data in a “natural experiment”, testing their theory that surgeons would get quicker as they warmed up, in this case by repeating a procedure.  The data analysis covered both key-hole and open surgery.


“The evidence from the literature and some of our previous work is demonstrating that warm-up has the potential to make surgery safer and more efficient.”

Dr Faisal Mushtaq, Pyschologist, Leeds Institute for Data Analytics & School of Psychology


After controlling factors that affect the outcomes of surgery, for example a patient’s age and severity of illness, it was found that surgeons completed the second operation on a list more quickly than the first. That reduction in operating time was consistent across all 35 procedures analysed and amounted to just over six per cent of operating time. If surgeons switched between procedures, the time taken to complete the procedure increased by an average of just under 6.5 per cent.


Dr Mushtaq and colleagues are now looking at the use of virtual and augmented reality techniques to help surgeons warm up for extremely challenging procedures such as brain tumour surgery.  He said: “The use of VR will allow surgeons to practice in a virtual environment and technology will allow these virtual images to be turned into ‘holograms’ that can be overlaid on top of a real tumour in theatre – helping the surgical team to plan and visualise the processes involved in the procedure they are about to carry out before the first incision. We hope this new technology will help surgeons perform at an elite level in every operation.”


Research Published in the British Journal of Surgery: Operating list composition and surgical performance
T. W. Pike, F. Mushtaq, R. P. Mann, P. Chambers, G. Hall, J. E. Tomlinson, R. Mir, R. M. Wilkie, M. Mon‐Williams, J. P. A. Lodge

The study is available to view here.