The Surgeon’s Prayer: Rituals, Habits, and Superstitions Before the First Cut The Rituals Surgeons Perform Before The First Incision

Abstract

Introduction: Pre-operative rituals are common in many high-stakes professions, yet little is known
about their prevalence or perceived role among surgeons. This exploratory study investigated
the nature, origins, and significance of pre-operative rituals in contemporary surgical practice.
Methods: We distributed an anonymous cross-sectional online survey through international pro-
fessional surgical networks using snowball sampling. The survey explored the prevalence, origins,
purpose, and perceived importance of pre-operative rituals, together with their relationship to
procedure complexity and operative performance.
Results: A total of 143 surgeons from multiple specialties and countries participated. Overall, 70%
reported performing personal rituals or routines before surgery. Most rituals were established
during training (58%) and were self-developed rather than learned from mentors (81%). Personal
habit (30%) and psychological preparation (28%) were the most frequently cited reasons for ritual
behaviour, whereas only 6% identified superstition as the primary basis. Rituals were generally
unaffected by procedure complexity (70%), and most respondents reported little perceived
impact on performance if unable to follow them (82%). Nevertheless, approximately two-thirds
considered their rituals at least moderately important. Free-text responses consistently described
rituals as enhancing focus, confidence, emotional regulation, and readiness for surgery.
Conclusions: Pre-operative rituals are common among surgeons and appear to function primarily
as psychological strategies for preparing for high-stakes operative performance rather than as
expressions of superstition. These findings highlight an under-recognised aspect of surgical prac-
tice and suggest that personal rituals may contribute to the cognitive and emotional preparation
required for surgery.