Mapping Distractions in the Hybrid Operating Room During Elective Endovascular Aortic Procedures

The hybrid operating room (OR) is a complex environment where numerous auditory and visual stimuli are encountered, potentially affecting team performance and postoperative outcomes. This study aimed to quantify distractions during elective endovascular aortic procedures in a hybrid OR using audiovisual data collected with a medical data recorder.

This retrospective, observational, single-center study analyzed elective endovascular procedures for aneurysmal or occlusive atherosclerotic disease in a hybrid OR using the OR Black Box (Surgical Safety Technologies Inc., Toronto, Canada). Distractions were characterized using a modified Disruptions in Surgery Index. Descriptive and nonparametric statistics were used to describe the number of distractions per procedural phase. Associations of distractions with total surgical time and observed number of healthcare workers present in the OR were examined.

Twenty-two endovascular procedures were analyzed with good to excellent interrater (ICC 0.86) and intrarater (ICC 0.89, 0.96) reliability. Median surgical time was 110 min (IQR 73-138). Distractions were observed at a median rate of 81 per hour (IQR 67-94), with internal traffic being most frequent (36 per hour; IQR 31-46). Significantly more distractions occurred during the closing phase (p < 0.001). Total surgical time and number of healthcare workers were not associated with the number of distractions per hour.

Distractions occur frequently in the hybrid OR and can be mapped with a medical data recorder. Further research is needed to unravel the impact of distractions on clinical outcomes and to evaluate quality improvement initiatives to reduce distractions during surgery.