Factors associated with surgeon's perception of distraction in the operating room

Surg Endosc. 2020 Jul;34(7):3169-3175. doi: 10.1007/s00464-019-07088-z. Epub 2019 Aug 27.


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 265 consecutive patients undergoing elective laparoscopic general surgery during the 2 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 model, we determined which intraoperative sources of distraction were associated with the surgeons feeling distracted in the OR.

Results: The attending surgeon reported feeling distracted in 120 of 265 operations (45%). Auditory sources of distraction, such as the OR door opening occurred at a median of 41 times per case (interquartile range (IQR), 32-54). Cognitive distractions such as teaching (142 cases (54%)), device malfunction (91 (34%)), irrelevant conversations (72 (27%)), management of the next case (41 (15%)), and time pressure (22 (8%)) occurred in a significant number of operations. In a multivariable analysis, presence of irrelevant conversations (odds ratio 2.14, 95% confidence interval (CI) 1.16-3.94, p = 0.015) and patient history of previous abdominal surgery (odds ratio 2.2, 95% CI 1.18-4.1, p = 0.013) 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 surgeon's perception of distraction.

Keywords: Distraction; Human factors; Patient safety.

MeSH terms

  • Attention
  • Clinical Competence
  • Digestive System Surgical Procedures*
  • Elective Surgical Procedures
  • Female
  • Gastric Bypass
  • Humans
  • Laparoscopy*
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Operating Rooms*
  • Perception
  • Prospective Studies
  • Surgeons / psychology*
  • Time Factors