International Centre for Surgical Safety, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 209 Victoria Street, 8th Floor East, Toronto, ON, M5B 1T8, Canada.
Department of Surgery, University of Toronto, Toronto, ON, Canada.
Surg Endosc. 2020 Jul;34(7):3169-3175. doi: 10.1007/s00464-019-07088-z. Epub 2019 Aug 27.
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.
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.
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.
Irrelevant conversation in the OR is a modifiable factor that was independently associated with surgeon's perception of distraction.
手术室（OR）中的干扰会给外科医生带来压力，并导致更多错误和不良事件发生的可能性。目的是确定与外科医生分心感知相关的术中因素。
我们在 265 例连续接受择期腹腔镜普外科手术的患者中进行了一项前瞻性队列研究，在实施名为 OR 黑盒的数据采集系统后的 2 年内，确定术中干扰源。在每次手术结束时，进行人为因素调查，以评估外科医生是否感到分心。使用多变量逻辑模型，我们确定了与外科医生在 OR 中感到分心相关的术中干扰源。
在 265 例手术中，主治外科医生报告有 120 例（45%）感到分心。听觉干扰源，如手术室门打开，中位数发生 41 次/例（四分位距 32-54）。认知干扰源，如教学（142 例（54%））、设备故障（91 例（34%））、无关对话（72 例（27%））、下一个病例的管理（41 例（15%））和时间压力（22 例（8%））在大量手术中发生。多变量分析显示，无关对话（比值比 2.14，95%置信区间（CI）1.16-3.94，p=0.015）和患者既往腹部手术史（比值比 2.2，95%CI 1.18-4.1，p=0.013）与外科医生感到分心的可能性增加独立相关。
手术室中的无关对话是一个可改变的因素，与外科医生的分心感知独立相关。
