gms | German Medical Science

131. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

25.03. - 28.03.2014, Berlin

The impact of intraoperative interruptions on surgeons’ workload: A prospective study in elective general and orthopaedic surgery

Meeting Abstract

  • Costanza Chiapponi - Universitätsklinikum Magdeburg, Klinik für Allgemeine, Viszeral- und Gefäßchirurgie, Magdeburg
  • Sophia Antoniadis - Klinikum der LMU München, Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, München
  • Christiane J. Bruns - Klinikum der LMU München, Klinik für Allgemeine, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, München
  • Matthias Weigl - Klinikum der LMU München, Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, München

Deutsche Gesellschaft für Chirurgie. 131. Kongress der Deutschen Gesellschaft für Chirurgie. Berlin, 25.-28.03.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. Doc14dgch549

doi: 10.3205/14dgch549, urn:nbn:de:0183-14dgch5494

Published: March 21, 2014

© 2014 Chiapponi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Introduction: Surgeons’ intraoperative workload is critical for effective and safe surgical performance. Detrimental conditions of the operating room (OR) environment may add to surgeons’ load and jeopardize surgical outcomes. The study addresses the impact of different intraoperative workflow interruptions on surgeons’ capability to manage their subjective workload in a safe and efficient manner.

This study aimed to examine the prospective impact of various intraoperative interruptions on surgeons’ workload.

Material and methods: A prospective study of full case observations with workload ratings from two surgical specialties (general, orthopaedic/trauma surgery). Intraoperative interruptions were assessed via expert observation using a well-validated observation tool. Surgeons assessed their workload directly after case completion based on three items of the validated Surgery Task Load Index (SURG-TLX; mental demands, situational stress, distractions).

Results: 56 elective cases with 94 workload ratings were included. Mean intraoperative time was 1.37 hours. Intraoperative interruptions were on average observed 9.8 times per hour. Persons that entered/exited the OR (30.6%) as well telephone/bleeper related disruptions (23.6%) occurred most often. Most disruptive interferences with surgical team functioning were observed for equipment- and OR-environment related interruptions. After identifying task and procedural influences, partial correlational analyses revealed that case-irrelevant communication were negatively related with surgeons’ mental fatigue and situational stress whereas surgeons’ reported distraction was prospectively influenced by case irrelevant communication and procedural disruptions.

Conclusion: Our study documents the unique contribution of different interruptions on surgeons’ workload: whereas case irrelevant communication may be beneficial for mental fatigue and stress in routine cases, procedural interruptions and case irrelevant communication may deteriorate surgeons’ mental focus. Thus, well-designed OR environments, careful surgical leadership, and awareness shall help to control interruptions for effective and safe surgical care.