Environment influences OR team performance

Editor's Note

Temperature, lighting, and noise can negatively influence surgical performance, according to new research published November 11 in Surgical Endoscopy. A systematic review of 34 studies examining the impact of lighting, temperature, noise, and music on the performance of surgical teams sought to understand how these environmental factors can influence operative performance measured through staff cognitive workload, operative skills, and patient outcomes.

The investigators studied three key areas of surgical team performance, including assessment of technical skills, such as suturing; cognitive and psychological load and mental fatigue; and patient outcome metrics such as postoperative complications. The review findings demonstrated that noise regularly exceeded recommended standards and was associated with increased mental workload and incidence of complications. Although music increased decibels, it was viewed positively by those participating in reviewed studies, despite not objectively enhancing performance. Increased temperature was associated with less comfort but did not reduce technical or cognitive performance. Increased illumination reduced tiredness in some participants, per the report.

In contrast to noise influencing all staff in an operating room, temperature fluctuation was found to be more individual-specific and investigators suggested temperature adjustment may require more compromise among teams. Limited research on lighting and humidity identified in the review led the investigators to note that more research is needed in this area. They did suggest that surgeons should consider modifiable environmental factors as part of a systems approach to optimizing operative performance, patient safety, and staff-wellbeing.