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Am J Surg. 2010 Jan;199(1):60-5. doi: 10.1016/j.amjsurg.2009.07.036.

Factors compromising safety in surgery: stressful events in the operating room.

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Department of Biosurgery and Surgical Technology, Imperial College London, 10th Floor QEQM, St Mary's Hospital, South Wharf Rd., London W2 1NY, UK.



Stressful events occur in the operating room (OR) with potentially severe consequences for patient safety. We recorded the incidence of these events in the OR, assessed the levels of stress that they caused, and investigated their detectability.


Stressful incidents in the OR were recorded and rated in real time by an observer in 55 general and orthopedic procedures. Operating surgeons also rated incident stressfulness and their stress (validated State Trait Anxiety Inventory).


The total count of stressors/case ranged from 1 to 23.5 (mean, 5.87). Technical, patient, and equipment problems occurred frequently and were most stressful. Frequent but least severe stressors were distractions/interruptions, whereas least frequent/most severe stressors were teamwork problems. These events were associated with an increase in surgeons' self-reported stress. The observer was able to capture surgeons' stress accurately.


Systematically occurring stressors in the OR affect surgeons and can be assessed accurately. Further research should investigate the impact of stress on surgical performance.

[Indexed for MEDLINE]

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