Effects of surgical flow disruptions on surgeons’ resources: a pilot study

Houwelingen, B. C. G. van; Rutkowski, A.F.; Ganni, Sandeep; Stepaniak, Pieter S.; Jakimowicz, Jack J.

doi:10.1007/s00464-019-07239-2

Cited by 7 publications

(12 citation statements)

References 40 publications

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“…First, some consequences of frequent FDs on performance cannot be detected by our study design: this includes long-term effects of FDs on surgeon’s decision making, mental resources, and fatigue, as well as accumulated effects of consecutive FDs (i.e. FD cascades) [ 12 , 54 ]. It has been suspected that only severe or accumulated FDs may have a negative effect on surgical performance [ 55 ].…”

Section: Discussionmentioning

confidence: 99%

Intraoperative dynamics of workflow disruptions and surgeons' technical performance failures: insights from a simulated operating room

et al. 2021

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Introduction Flow disruptions (FD) in the operating room (OR) have been found to adversely affect the levels of stress and cognitive workload of the surgical team. It has been concluded that frequent disruptions also lead to impaired technical performance and subsequently pose a risk to patient safety. However, respective studies are scarce. We therefore aimed to determine if surgical performance failures increase after disruptive events during a complete surgical intervention. Methods We set up a mixed-reality-based OR simulation study within a full-team scenario. Eleven orthopaedic surgeons performed a vertebroplasty procedure from incision to closure. Simulations were audio- and videotaped and key surgical instrument movements were automatically tracked to determine performance failures, i.e. injury of critical tissue. Flow disruptions were identified through retrospective video observation and evaluated according to duration, severity, source, and initiation. We applied a multilevel binary logistic regression model to determine the relationship between FDs and technical performance failures. For this purpose, we compared FDs in one-minute intervals before performance failures with intervals without subsequent performance failures. Results Average simulation duration was 30:02 min (SD = 10:48 min). In 11 simulated cases, 114 flow disruption events were observed with a mean hourly rate of 20.4 (SD = 5.6) and substantial variation across FD sources. Overall, 53 performance failures were recorded. We observed no relationship between FDs and likelihood of immediate performance failures: Adjusted odds ratio = 1.03 (95% CI 0.46–2.30). Likewise, no evidence could be found for different source types of FDs. Conclusion Our study advances previous methodological approaches through the utilisation of a mixed-reality simulation environment, automated surgical performance assessments, and expert-rated observations of FD events. Our data do not support the common assumption that FDs adversely affect technical performance. Yet, future studies should focus on the determining factors, mechanisms, and dynamics underlying our findings.

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Section: Discussionmentioning

confidence: 99%

Intraoperative dynamics of workflow disruptions and surgeons' technical performance failures: insights from a simulated operating room

et al. 2021

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“…Van Houwelingen et al showed that experts in laparoscopic procedures exhibit fewer physical reactions than novices to disturbances during surgery. [ 22 ]. Moorthy et al tested 12 surgeons with different levels of expertise (4 experts and 8 novices) on a laparoscopic trainer, using three levels of noise: quiet, 80–85 dB, and music.…”

Section: Discussionmentioning

confidence: 99%

“…A few studies have demonstrated the negative impact of disruptive factors on the surgical performance of students and surgical novices practicing on a virtual reality trainer [ 5 ]. Experienced surgeons performing conventional surgery have been tested for the impact of disruptive factors [ 9 , 20 , 21 , 22 ]. However, data concerning the impact of distractions on surgical performance among experienced surgeons performing minimally invasive surgery are scarce [ 22 ].…”

Section: Introductionmentioning

confidence: 99%

“…Experienced surgeons performing conventional surgery have been tested for the impact of disruptive factors [ 9 , 20 , 21 , 22 ]. However, data concerning the impact of distractions on surgical performance among experienced surgeons performing minimally invasive surgery are scarce [ 22 ]. To the best of our knowledge, we lack any comparison of the impact of distractions on the surgical performance of experts and novices on virtual reality trainers, robotic surgery, or laparoscopic surgery.…”

Section: Introductionmentioning

confidence: 99%

“…However, we lack a common definition for the terms “expert” and “beginner.” As a result, different methods of classification have been used. Distinctions have been made on the basis of professional experience in years, number of operations, or even self-assessment [ 22 , 23 , 24 , 25 , 26 , 27 ]. Specific conditions and the numbers of subgroups in the individual studies vary widely.…”

Section: Introductionmentioning

confidence: 99%

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Impact of Acoustic and Interactive Disruptive Factors during Robot-Assisted Surgery—A Virtual Surgical Training Model

Krüger

Ackermann

Bauerschlag

et al. 2020

Sensors

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The use of virtual reality trainers for teaching minimally invasive surgical techniques has been established for a long time in conventional laparoscopy as well as robotic surgery. The aim of the present study was to evaluate the impact of reproducible disruptive factors on the surgeon’s work. In a cross-sectional investigation, surgeons were tested with regard to the impact of different disruptive factors when doing exercises on a robotic-surgery simulator (Mimic Flex VRTM). Additionally, we collected data about the participants’ professional experience, gender, age, expertise in playing an instrument, and expertise in playing video games. The data were collected during DRUS 2019 (Symposium of the German Society for Robot-assisted Urology). Forty-two surgeons attending DRUS 2019 were asked to participate in a virtual robotic stress training unit. The surgeons worked in various specialties (visceral surgery, gynecology, and urology) and had different levels of expertise. The time taken to complete the exercise (TTCE), the final score (FSC), and blood loss (BL) were measured. In the basic exercise with an interactive disruption, TTCE was significantly longer (p < 0.01) and FSC significantly lower (p < 0.05). No significant difference in TTCE, FSC, or BL was noted in the advanced exercise with acoustic disruption. Performance during disruption was not dependent on the level of surgical experience, gender, age, expertise in playing an instrument, or playing video games. A positive correlation was registered between self-estimation and surgical experience. Interactive disruptions have a greater impact on the performance of a surgeon than acoustic ones. Disruption affects the performance of experienced as well as inexperienced surgeons. Disruption in daily surgery should be evaluated and minimized in the interest of the patient’s safety.

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Associations of flow disruptions with patient, staff, and process outcomes: a prospective observational study of robotic-assisted radical prostatectomies

et al. 2023

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Background Technological advancements in the operating room (OR) have sparked new challenges for surgical workflow, OR professionals, and patient safety. Disruptive events are frequent across all surgical specialties, but little is known about their effects on patient outcomes and the influence of systemic factors. The aim was to explore the associations of intraoperative flow disruptions (FDs) with patient outcomes, staff workload, and surgery duration. Methods Prospective, single-center, and multi-source study comprising direct and standardized OR observations of urologic surgical procedures, clinical patient outcomes, and staff- and patient-reported outcome data (PROMs; 3-month follow-up). All data were recorded between 01/2020 and 10/2021. FDs were assessed using standardized procedure observations. Linear and logistic regression analyses including multiple system factors were used to explore the effects of FDs on surgical outcomes. Results 61 robotic-assisted radical prostatectomy procedures were captured (with 61 patients and 243 staff reports). High rates of FDs were observed; however, our analyses did not show significant relationships with patient complication rates. Equipment- and patient-related FDs were associated with increased staff workload. No association was found between higher rates of FDs and procedure duration. Conclusions FDs were not related to inferior patient outcomes. Our findings may inform future OR investigations that scrutinize the complex interplay of human, team, process, and technological components that mitigate the effects of FDs during surgery. Graphical abstract

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Effects of surgical flow disruptions on surgeons’ resources: a pilot study

Abstract: Important note To cite this publication, please use the final published version (if applicable). Please check the document version above.

Cited by 7 publications

References 40 publications

Intraoperative dynamics of workflow disruptions and surgeons' technical performance failures: insights from a simulated operating room

Intraoperative dynamics of workflow disruptions and surgeons' technical performance failures: insights from a simulated operating room

Impact of Acoustic and Interactive Disruptive Factors during Robot-Assisted Surgery—A Virtual Surgical Training Model

Associations of flow disruptions with patient, staff, and process outcomes: a prospective observational study of robotic-assisted radical prostatectomies

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