Journal of American College of Surgeons study finds warm-up helps surgeons improve performance

CHICAGO (February 2, 2009) – New research published in the February issue of the Journal of the American College of Surgeons shows a warm-up of 15 to 20 minutes with simple surgical exercises prior to an operation leads to a substantial increase in proficiency of surgical skills in surgeons of all experience levels. The researchers found that a warm-up of both psychomotor and cognitive skills raises surgeons' alertness to a higher level for surgical procedures and improves performance for fatigued surgeons.

The advent of minimally invasive surgery has created new challenges for surgeons, requiring them to perform procedures with difficult-to-manipulate tools that constrain movement. Although new developments such as surgical robotics and more intuitive surgical instruments have addressed some of these issues, modern-day surgical practice often entails prolonged, strenuous cognitive performance as well.

"Warm-up exercises are a 'common sense' practice in many high-stakes professions, such as professional sports or dance," said Kanav Kahol, Ph.D., department of biomedical informatics, Arizona State University, Tempe. "This study begins to lay a scientific foundation for adopting this approach in routine surgical practice, which has become increasingly rigorous and demanding."

Forty-six surgeons across varying specialties and experience levels participated in the study. Subjects performed standardized exercises as a preoperative warm-up. Afterwards, the standardized exercises were repeated in randomized order to examine proficiencies in psychomotor and cognitive skills involved in surgical procedures. Proficiencies were measured by gesture-level proficiency, hand-movement smoothness, tool-movement smoothness, time elapsed and cognitive errors. Additionally, the researchers investigated generalizability of preoperative warm-up by following it with a different task, electrocautery simulation. They also examined the effect of the warm-up on fatigued participants based on their performance before and after night call.

The results showed statistically significant improvements after all of the post warm-up exercises (p<0.01) and across all experience levels. In addition, the warm-up exercises led to a significant increase in proficiency in follow-up electrocautery simulation (p<0.0001). There was also a significant improvement in performance of the fatigued group compared to baseline performance (p<0.05), although the surgeons in this group were still not able to reach optimal potential performance.

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and to improve the care of the surgical patient. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 74,000 members and is the largest organization of surgeons in the world. For more information, visit www.facs.org.