Intraoperative Stress in Operating Teams in Otorhinolaryngology: Thematic Analysis of Semi-structured Interviews

Introduction Microsurgery and operating rooms (ORs) require exceptional focus, resilience, and coordination. Regardless of each’s professional role, intraoperative stress permeates the OR environment, disrupting interpersonal synchrony and potentially compromising surgical outcomes and patient safety. While surgery is inherently collaborative, previous research on intraoperative stress has largely focused on surgeons, overlooking the entire OR team. This study aims to broaden the understanding of intraoperative stress by examining individual and collective stressors across OR professions, their impact, and long-term coping strategies. Methods A single-site qualitative study using semi-structured interviews and thematic analysis was conducted. Participants included specialists, residents, circulating/head nurses, and nurse anesthetists. The interviews explored four themes: intraoperative stressors, professional experiences, teamwork, and coping strategies. Results Major and open conflicts were extremely rare, but tacit tensions emerged during prolonged or complex procedures, particularly with interprofessional teams. While individual stressors and coping strategies differed by profession, the collective coping strategies relied mainly on timely and effective communication. Especially when OR teams comprised newcomers, intentionality in communication mitigated stress. Finally, to support and be supported were both expected and nurtured strategies in the OR. Conclusion Effective communication and teamwork are interdependent and dynamic mechanisms that strengthen OR teams’ resilience to stress. Our work highlights the underexplored aspects of intraoperative stress across multiple professions and provides evidence from an authentic work environment in the OR. The findings can directly inform the curricula of the medical training programs and improve the overall well-being of OR teams, leading to healthier and more effective working environments.