James Jung, Jonah Elfassy, Teodor Grantcharov. University of Toronto
Background: Distractions in the operating room (OR) can create stress among surgeons and lead to higher chances of errors and adverse events. The objective is to determine intraoperative factors that are associated with surgeons’ perception of distraction.
Methods: We conducted a prospective cohort study in 287 consecutive patients undergoing elective laparoscopic general surgery during the two years after the implementation of a data capture system called the OR Black Box to identify intraoperative sources of distraction. At the end of each operation, human factor surveys were administered to assess whether surgeons felt distracted. Using a multivariable logistic mixed model with random intercepts for individual surgeons, we determined which intraoperative sources of distraction were associated with the surgeons feeling distracted in the OR.
Results: Surgeons reported feeling distracted in 125 of 287 operations (44%). Auditory sources of distraction, such as the OR door opening occurred at a median of 41 times per case (interquartile range (IQR), 32-54) and external noise occurred at a median of 95 times per case (IQR, 65-133). Cognitive distractions such as teaching (155 operations (54%)), device malfunction (100 (35%)), irrelevant conversations (75 (26%)), management of the next case (44 (15%)), and time pressure (22 (8%)) occurred in a significant number of operations. In a multivariable analysis, presence of irrelevant conversations (odds ratio 1.89, p=0.03) and longer procedure duration (1.02, p<0.01) were independently associated with increased likelihood of the surgeons feeling distracted.
Conclusions: Irrelevant conversation in the OR is a modifiable factor that was independently associated with surgeons’ perception of distraction.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95610
Program Number: S159
Presentation Session: OR Efficiency & Outcomes
Presentation Type: Podium