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Intra-operative disruptions, surgeon’s mental workload, and technical performance in a full-scale simulated procedure

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Abstract

Background and aim

Surgical flow disruptions occur frequently and jeopardize perioperative care and surgical performance. So far, insights into subjective and cognitive implications of intra-operative disruptions for surgeons and inherent consequences for performance are inconsistent. This study aimed to investigate the effect of surgical flow disruption on surgeon’s intra-operative workload and technical performance.

Methods

In a full-scale OR simulation, 19 surgeons were randomly allocated to either of the two disruption scenarios (telephone call vs. patient discomfort). Using a mixed virtual reality simulator with a computerized, high-fidelity mannequin, all surgeons were trained in performing a vertebroplasty procedure and subsequently performed such a procedure under experimental conditions. Standardized measures on subjective workload and technical performance (trocar positioning deviation from expert-defined standard, number, and duration of X-ray acquisitions) were collected.

Results

Intra-operative workload during simulated disruption scenarios was significantly higher compared to training sessions (p < .01). Surgeons in the telephone call scenario experienced significantly more distraction compared to their colleagues in the patient discomfort scenario (p < .05). However, workload tended to be increased in surgeons who coped with distractions due to patient discomfort. Technical performance was not significantly different between both disruption scenarios. We found a significant association between surgeons’ intra-operative workload and technical performance such that surgeons with increased mental workload tended to perform worse (β = .55, p = .04).

Conclusions

Surgical flow disruptions affect surgeons’ intra-operative workload. Increased mental workload was associated with inferior technical performance. Our simulation-based findings emphasize the need to establish smooth surgical flow which is characterized by a low level of process deviations and disruptions.

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Acknowledgments

The study was funded by the Research and Teaching Program of the Medical Faculty, Munich University (FöFoLE, Grant No. 752) and the Munich Centre for Health Sciences (Mc-Health). We acknowledge Alexander Winkler and Professor Dr. Wolf E. Mutschler for their support in study preparation and data collection. We also gratefully acknowledge Professor Franziska Tschan and Professor Norbert Semmer for their valuable comments on an earlier version.

Disclosures

Matthias Weigl, Philipp Stefan, Kamyar Abhari, Patrick Wucherer, Pascal Fallavollita, Marc Lazarovici, Simon Weidert, Ekkehard Euler, and Ken Catchpole declare that they have no competing interests. The authors also indicate that they have no personal financial relationships relevant to this article to disclose.

Ethical standard

This study was conducted with the approval of the Ethics Committee of the Medical Faculty of the Ludwig-Maximilians-University, Munich (No. 397-13).

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Authors and Affiliations

  1. Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, 80336, Munich, Germany

    Matthias Weigl

  2. Computed Aided Medical Procedures (CAMP), Computer Science Department (I-16), Technical University of Munich, Munich, Germany

    Philipp Stefan, Patrick Wucherer & Pascal Fallavollita

  3. Imaging Research Laboratories, Robarts Research Institute, The University of Western Ontario, London, Canada

    Kamyar Abhari

  4. Institute for Emergency Medicine and Management in Medicine (INM), Ludwig-Maximilians-University Munich, Munich, Germany

    Marc Lazarovici

  5. Department of Trauma Surgery, Ludwig-Maximilians-University Munich, Munich, Germany

    Simon Weidert & Ekkehard Euler

  6. Surgical Safety and Human Factors Research, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Ken Catchpole

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  1. Matthias Weigl
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Correspondence to Matthias Weigl.

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Weigl, M., Stefan, P., Abhari, K. et al. Intra-operative disruptions, surgeon’s mental workload, and technical performance in a full-scale simulated procedure. Surg Endosc 30, 559–566 (2016). https://doi.org/10.1007/s00464-015-4239-1

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  • DOI: https://doi.org/10.1007/s00464-015-4239-1

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