Impact of the complexity of surgical procedures and intraoperative interruptions on neurosurgical team workload

Neurosurgical teams are exposed to various stressors: complexity of surgical procedures, environment, time pressure and interruptions contribute to increasing the perceived workload.

This study aimed to evaluate the impact of interruptions and surgical complexity on neurosurgical team workload.

A prospective observational study was conducted on thirty surgical procedures of graduated complexity recorded in our Department of Neurosurgery. A scale was created and used by neurosurgeons to evaluate the perceived complexity of the surgical procedure. Interruptions and severity of interruptions were noted. The workloads of the neurosurgeon, surgical assistant, scrub nurse and circulating nurse were measured on the Surgery Task Load Index (SURG-TLX) at the end of the procedure.

A mean 24.6 interruptions per hour were recorded. The mean interference level of the interruptions was 3.5/7. Mean surgical complexity was 4.3/10. Mean sterile team workload was 43.4/100. The multiple linear regression model showed that sterile team workload increased with surgical complexity (β=6.692, P=.0002) but decreased in spite of increases in the number of interruptions per hour (β=-0.855, P=.027). Neurosurgeon and surgical assistant workload increased with surgical complexity (β=11.53, P<0.0001 and β=7.42, P=0.0007, respectively). Scrub nurse workload decreased in spite of increases in the number of interruptions per hour (β=-1.11, P=.026).

Our study suggests positive effects of some interruptions during elective neurosurgical procedures with strong team familiarity.