WTP7.05 Light, heat and noise - the impact of operating room environmental factors on surgical performance: a systematic review

Aims In the past decade, much attention has been paid to individual and team dynamics in surgery. However, the role of the physical environment remains neglected. Environmental factors including lighting, noise and thermodynamics are regulated in high-risk workplaces worldwide. Such environmental factors are not beyond surgeon control, and when combined could exert significant influence on performance. However, the nature and true impact of modifiable environmental factors on performance outcomes for surgeons are not fully understood. Methods A systematic review was conducted by searching EMBASE, Medline, Pubmed and Cochrane Central. Environmental factors included lighting, temperature, noise and music. Eligible studies examined their impact on performance of surgeons, anaesthetists and nurses. Articles were screened independently by three reviewers and data on analysis and performance outcomes were extracted. Results From 8410 articles screened, 31 met inclusion criteria (n=3915 participants). 14 studies assessed the performance impact of noise, 6 of music, 4 of noise and music, 5 of temperature and 1 of lighting. Increased temperature made staff subjectively more uncomfortable, but did not impact technical or cognitive performance. Noise regularly exceeded recommended standards and was associated with increased complications and mental workload. Although music contributed to an increase in decibels, it was viewed positively by the majority, despite having no objective performance benefit. Conclusion The implementation of systems in operating theatres that reduce noise is key to safeguard patient safety and staff well-being. Temperature is highly individual-specific and may require compromise between team members. There is a paucity of research on surgical lighting.