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First-year Analysis of the Operating Room Black Box Study

Jung, James J., MD*,†,‡; Jüni, Peter, MD‡,§; Lebovic, Gerald, PhD‡,§; Grantcharov, Teodor, MD, PhD*,†,‡

doi: 10.1097/SLA.0000000000002863
Original Article: PDF Only

Objective: To characterize intraoperative errors, events, and distractions, and measure technical skills of surgeons in minimally invasive surgery practice.

Background: Adverse events in the operating room (OR) are common contributors of morbidity and mortality in surgical patients. Adverse events often occur due to deviations in performance and environmental factors. Although comprehensive intraoperative data analysis and transparent disclosure have been advocated to better understand how to improve surgical safety, they have rarely been done.

Methods: We conducted a prospective cohort study in 132 consecutive patients undergoing elective laparoscopic general surgery at an academic hospital during the first year after the definite implementation of a multiport data capture system called the OR Black Box to identify intraoperative errors, events, and distractions. Expert analysts characterized intraoperative distractions, errors, and events, and measured trainee involvement as main operator. Technical skills were compared, crude and risk-adjusted, among the attending surgeon and trainees.

Results: Auditory distractions occurred a median of 138 times per case [interquartile range (IQR) 96–190]. At least 1 cognitive distraction appeared in 84 cases (64%). Medians of 20 errors (IQR 14–36) and 8 events (IQR 4–12) were identified per case. Both errors and events occurred often in dissection and reconstruction phases of operation. Technical skills of residents were lower than those of the attending surgeon (P = 0.015).

Conclusions: During elective laparoscopic operations, frequent intraoperative errors and events, variation in surgeons’ technical skills, and a high amount of environmental distractions were identified using the OR Black Box.

*International Centre for Surgical Safety, Keenan Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada

Department of Surgery, University of Toronto, Toronto, ON, Canada

Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada

§Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.

Reprints: James J. Jung, MD, 209 Victoria Street, 8th Floor East, Toronto, ON M5B 1T8, Canada. E-mail:

Conflicts of interests: Dr Grantcharov holds intellectual property ownership of Surgical Safety Technologies Inc. and is supported by research grants from Medtronic Canada, Ethicon Canada, Baxter Canada, Olympus Canada, Takeda Canada, and Intuitive Canada. Drs Jung, Jüni, and Lebovic have nothing to declare.

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