The prone position during surgery and its complications: A systematic review and evidence-based guidelines

Melissa M Kwee, Yik-Hong Ho, Warren M Rozen

Research output: Contribution to journalArticleOther

142 Citations (Scopus)


Surgery in the prone position is often a necessity when access to posterior anatomic structures is required. However, many complications are known to be associated with this type of surgery, as physiologic changes occur with increased pressure to anterior structures. While several studies have discussed postoperative vision loss, much fewer studies with lower levels of evidence have addressed other complications. A systematic literature review was conducted using 2 different databases, and 53 papers were regarded as appropriate for inclusion. Qualitative and quantitative analysis was performed. Thirteen complications were identified. Postoperative vision loss and cardiovascular complications, including hypovolemia and cardiac arrest, had the most number of studies and highest level of evidence. Careful planning for optimal positioning, padding, timing, as well as increased vigilance are evidence-based recommendations where operative prone positioning is required.
Original languageEnglish
Pages (from-to)292-303
Number of pages12
JournalInternational Surgery
Issue number2
Publication statusPublished - 1 Feb 2015


  • Complications
  • Evidence based medicine
  • Prone
  • Qualitative and quantitative methods
  • Retinal
  • Supine
  • Surgery
  • Trunk

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