Surgeons’ Perspectives on Optimal Patient Positioning During Simultaneous Cranial Procedures and Exploratory Laparotomy

Abstract

Patients presenting with traumatic intracranial and intraabdominal injuries often require emergent care. Triage of injuries is based on severity of the individual injuries, but treatment occasionally must proceed simultaneously. Determining an optimal patient position at the time of surgery often produces unnecessary delays and this delay may negatively affect patient outcome. This study aimed to determine an operative patient position that simultaneously optimizes access to neurosurgical and general surgical teams without compromising sterility or severely affecting surgeon and anesthesia comfort. Photographs of traditional exploratory laparotomy patient positioning (position A), traditional supine craniotomy patient positioning (position B), and a hybrid patient position (position C) were presented to 29 general surgeons and 12 neurosurgeons at a single institution. Surgeons were asked to rate the positions on acceptability and to rank the three positions according to preference when simultaneous exploratory laparotomy and craniotomy were necessary. Position C was rated as an acceptable option by 82.8% of general surgeons and 100% of neurosurgeons. In addition, 51.9% of general surgeons and 81.8% of neurosurgeons preferred position C to their respective specialty's traditional patient positioning in situations that required simultaneous exploratory laparotomy and craniotomy. We present a novel hybrid operative patient position for use during simultaneous exploratory laparotomy and craniotomy. In doing so, we emphasize the importance of constructive dialogue among trauma surgeons and neurosurgeons in optimizing the care of acutely ill trauma patients with multisystem injuries.