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Navigating diversions in the obstetric operating room: focusing amidst distractions
Kaitlyn Voity1, Christina O'Leary1, Nicole P Jenkins2
1Hackensack Meridian School of Medicine (Voity, O'Leary, Wolford and Oladipo), Nutley, NJ 07110.
AJOG Global Reports
|February 12, 2026
Summary
Intraoperative distractions during cesarean deliveries are frequent, with moderate distractions significantly impacting cognitive load. While not affecting surgery length, higher distraction scores correlate with neonatal complications, highlighting the need for reduction strategies.
Area of Science:
- Obstetrics and Gynecology
- Patient Safety
- Surgical Workflow Analysis
Background:
- Operating room (OR) distractions can disrupt surgical workflow and patient safety.
- Intraoperative distractions during cesarean deliveries are understudied, despite complex team dynamics and dual-patient care.
- This study addresses the knowledge gap regarding distractions in the obstetric OR.
Purpose of the Study:
- To systematically characterize the frequency, types, and severity of intraoperative distractions during scheduled cesarean deliveries.
- To evaluate the association between distractions and surgical duration, as well as maternal or neonatal complications.
- To test the hypothesis that higher distraction scores correlate with longer procedure times and increased clinical complications.
Main Methods:
- Prospective observational study of 97 scheduled cesarean deliveries (≥37 weeks' gestation).
- Real-time recording of distractions using a validated categorization tool and severity grading (mild, moderate, severe).
- Calculation of a weighted distraction score per case, with analysis of procedure duration and complication rates.
Main Results:
- A total of 8113 distractions were documented (mean 81 per case).
- Door movement and teaching conversations were the most frequent distraction types; moderate distractions constituted the largest burden (44.5%).
- Severe distractions occurred in all cases; higher distraction scores were linked to neonatal intensive care unit (NICU) admissions.
Conclusions:
- Distractions in the obstetric OR are frequent and diverse, with moderate distractions significantly contributing to cognitive load.
- Increased distraction scores may be associated with neonatal complications, emphasizing the need for reduction strategies.
- While not linked to prolonged surgical duration, awareness of distraction impact on outcomes is crucial for healthcare providers.
Keywords:
academic health centerscesarean deliverycognitive loaddistractionshuman factorsintraoperative communicationmaternal safetyneonatal outcomesoperating room trafficsurgical complicationsteam performanceMore Related Videos
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