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A systematic review of the effect of distraction on surgeon performance: directions for operating room policy and surgical training

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Distractions during surgical procedures have been linked to medical error and team inefficiency. This systematic review identifies the most common and most significant forms of distraction in order to devise guidelines for mitigating the effects of distractions in the OR.


In January 2015, a PubMed and Google Scholar search yielded 963 articles, of which 17 (2 %) either directly observed the occurrence of distractions in operating rooms or conducted a laboratory experiment to determine the effect of distraction on surgical performance.


Observational studies indicated that movement and case-irrelevant conversation were the most frequently occurring distractions, but equipment and procedural distractions were the most severe. Laboratory studies indicated that (1) auditory and mental distractions can significantly impact surgical performance, but visual distractions do not incur the same level of effects; (2) task difficulty has an interaction effect with distractions; and (3) inexperienced subjects reduce their speed when faced with distractions, while experienced subjects did not.


This systematic review suggests that operating room protocols should ensure that distractions from intermittent auditory and mental distractions are significantly reduced. In addition, surgical residents would benefit from training for intermittent auditory and mental distractions in order to develop automaticity and high skill performance during distractions, particularly during more difficult surgical tasks. It is unclear as to whether training should be done in the presence of distractions or distractions should only be used for post-training testing of levels of automaticity.

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Design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication were supported by grants from the National Institute of Medicine (NIH NIBIB 2R01 EB005807-05A1, 1R01 EB010037-01, 1R01 EB009362-01A2, 1R01 EB014305-01A1) and the National Science Foundation (NSF IIS 1422671).

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Correspondence to Helena M. Mentis.

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Helena Mentis, Ph.D., Amine Chellali, Ph.D., Caroline G. L. Cao, Ph.D., Kelly Manser, B.A., and Steven D. Schwaitzberg, M.D. have no financial support from any private institution, and the authors have no financial relationships with any pharmaceutical or device companies.

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Mentis, H.M., Chellali, A., Manser, K. et al. A systematic review of the effect of distraction on surgeon performance: directions for operating room policy and surgical training. Surg Endosc 30, 1713–1724 (2016).

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