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However, there is a lack of awareness and clinical guidance regarding prevention of WLCS. The aim of this study was to assess current HDTL\u2010related practices and occurrence of WLCS among a global cohort of clinicians.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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. \u2018Leg rest\u2019 was the most reported preventive measure (41%), commonly initiated after 2 or 3\u2009h of HDTL (79%), for 10\u201315\u2009min (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 \u2018duration of uninterrupted HDTL\u2019 as a positive predictor of the occurrence of WLCS (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Perioperative practices during procedures in HDTL vary substantially, and are primarily informed by clinician experience and preferences. There is a need for evidence\u2010based consensus on best practices to enhance safety during procedures in HDTL.<\/jats:p><\/jats:sec>","DOI":"10.1111\/codi.70134","type":"journal-article","created":{"date-parts":[[2025,6,9]],"date-time":"2025-06-09T00:34:59Z","timestamp":1749429299000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Head\u2010down tilt lithotomy position and well\u2010leg compartment syndrome: An international survey of current practice"],"prefix":"10.1111","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0020-9325","authenticated-orcid":false,"given":"Chukwuemeka C.","family":"Uzoma","sequence":"first","affiliation":[{"name":"Clinical Health and Rehabilitation Team, School of Psychology, Sport and Health Sciences University of Portsmouth  Portsmouth UK"},{"name":"Department of Faculty Surgery RUDN University  Moscow Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony I.","family":"Shepherd","sequence":"additional","affiliation":[{"name":"Clinical Health and Rehabilitation Team, School of Psychology, Sport and Health Sciences University of Portsmouth  Portsmouth UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zoe L.","family":"Saynor","sequence":"additional","affiliation":[{"name":"School of Health Sciences, Faculty of Environmental and Life Sciences University of Southampton  Southampton UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3031-4495","authenticated-orcid":false,"given":"Jim S.","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Portsmouth Hospitals University NHS Trust  Portsmouth UK"},{"name":"Faculty of Science and Health University of Portsmouth  Portsmouth UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6667-9202","authenticated-orcid":false,"given":"Guglielmo Niccol\u00f2","family":"Piozzi","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Portsmouth Hospitals University NHS Trust  Portsmouth UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rauand","family":"Duhoky","sequence":"additional","affiliation":[{"name":"Department of Colorectal Surgery Portsmouth Hospitals University NHS Trust  Portsmouth UK"},{"name":"School of Computing, Faculty of Technology University of Portsmouth  Portsmouth UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Askew","sequence":"additional","affiliation":[{"name":"VasoActive Research Group, School of Health University of the Sunshine Coast  Sunshine Coast Queensland Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. 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