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Prevalence of Surgical Flow Disruptions Across Intra-operative High- and Low-Workload Phases in Cardiac Surgery

While the influence of surgical flow disruptions (SFDs) on surgical performance has been observed in live cardiovascular surgery and their influence on cognitive workload has been evaluated in high-fidelity simulations, the relationship between SFDs and cognitive workload of surgical providers in the live cardiac surgery operating room has yet to be explored. Recent evidence suggests that preventable surgical errors often have a cognitive basis, warranting investigation into the association between SFDs and workload. This study aimed to characterize SFDs according to auditory and cognitive domains and further to compare the frequency and nature of SFDs within periods of high team cognitive workload and low team cognitive workload. Overall, the presence of cognitive distractions was associated more with high team cognitive workload states, while the frequency of auditory distractions was significantly higher during periods of low team cognitive workload states. Future work should consider the types, frequency, and sources of SFDs as well as their impact on surgical procedures and outcomes in order to devise appropriate methods to mitigate or manage potential disruptions to surgical workflow.