Matthias Weigl1, Philipp Stefan2, Kamyar Abhari3, Patrick Wucherer2, Pascal Fallavollita2, Marc Lazarovici4, Simon Weidert5, Ekkehard Euler5, Ken Catchpole6. 1. Institute and Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-University Munich, Ziemssenstrasse 1, 80336, Munich, Germany. matthias.weigl@med.lmu.de. 2. Computed Aided Medical Procedures (CAMP), Computer Science Department (I-16), Technical University of Munich, Munich, Germany. 3. Imaging Research Laboratories, Robarts Research Institute, The University of Western Ontario, London, Canada. 4. Institute for Emergency Medicine and Management in Medicine (INM), Ludwig-Maximilians-University Munich, Munich, Germany. 5. Department of Trauma Surgery, Ludwig-Maximilians-University Munich, Munich, Germany. 6. Surgical Safety and Human Factors Research, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
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.
RCT Entities:
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.
Authors: Juliana J Brixey; David J Robinson; Craig W Johnson; Todd R Johnson; James P Turley; Jiajie Zhang Journal: ANS Adv Nurs Sci Date: 2007 Jan-Mar Impact factor: 1.824
Authors: Daniel Shouhed; Renaldo Blocker; Alex Gangi; Eric Ley; Jennifer Blaha; Daniel Margulies; Douglas A Wiegmann; Ben Starnes; Cathy Karl; Richard Karl; Bruce L Gewertz; Ken R Catchpole Journal: World J Surg Date: 2014-02 Impact factor: 3.352
Authors: Lauren Morgan; Eleanor Robertson; Mohammed Hadi; Ken Catchpole; Sharon Pickering; Steve New; Gary Collins; Peter McCulloch Journal: BMJ Open Date: 2013-11-25 Impact factor: 2.692
Authors: Roger D Dias; Heather M Conboy; Jennifer M Gabany; Lori A Clarke; Leon J Osterweil; David Arney; Julian M Goldman; Giuseppe Riccardi; George S Avrunin; Steven J Yule; Marco A Zenati Journal: OR 2.0 Context Aware Oper Theaters Comput Assist Robot Endosc Clin Image Based Proced Skin Image Anal (2018) Date: 2018-10-02
Authors: Lauren R Kennedy-Metz; Maria Arshanskiy; Sandra Keller; David Arney; Roger D Dias; Marco A Zenati Journal: IEEE Conf Cogn Comput Asp Situat Manag Date: 2022-07-22
Authors: P Stefan; M Pfandler; P Wucherer; S Habert; J Fürmetz; S Weidert; E Euler; U Eck; M Lazarovici; M Weigl; N Navab Journal: Unfallchirurg Date: 2018-04 Impact factor: 1.000