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

Matthias Weigl; Philipp Stefan; Kamyar Abhari; Patrick Wucherer; Pascal Fallavollita; Marc Lazarovici; Simon Weidert; Ekkehard Euler; Ken Catchpole

doi:10.1007/s00464-015-4239-1

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

Surg Endosc. 2016 Feb;30(2):559-566. doi: 10.1007/s00464-015-4239-1. Epub 2015 Jun 20.

Authors

Matthias Weigl¹, Philipp Stefan², Kamyar Abhari³, Patrick Wucherer², Pascal Fallavollita², Marc Lazarovici⁴, Simon Weidert⁵, Ekkehard Euler⁵, Ken Catchpole⁶

Affiliations

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.

PMID: 26091986
DOI: 10.1007/s00464-015-4239-1

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.

Keywords: Flow disruption; Performance; Simulation; Stress; Surgery; Workload.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Attention*
Clinical Competence*
Computer Simulation
Female
Humans
Male
Manikins
Surgeons / psychology*
User-Computer Interface
Vertebroplasty*
Workflow*
Workload / psychology*