Impact of environmental factors on operative team performance: systematic review and guidance for optimising clinical practice

OBJECTIVE: To evaluate the range and impact of environmental factors on the operative performance of surgical teams.

BACKGROUND: Optimising surgical performance is critical for patient safety and clinical efficiency. Recent efforts have focussed on both individual (e.g. stress-management, situation awareness) and team (e.g. communication, leadership) factors. However, the influence of environmental conditions within the operating room remains underexplored.

METHODS: A systematic review was conducted using EMBASE, Medline, PubMed, and CENTRAL for studies examining the impact of lighting, temperature, humidity, noise, and music on the performance of surgical teams, following PRISMA criteria. Outcomes assessed include operative skills, cognitive workload, and patient outcomes that may be a proxy for operative performance.

RESULTS: Of 9489 articles screened, 34 met inclusion criteria (n = 4159 participants). Fourteen studies assessed the impact of noise, eight of music, six of temperature, four of noise and music together, and two of lighting. No studies on humidity met the inclusion criteria. Noise regularly exceeded recommended standards and was associated with increased mental workload and incidence of complications. Although music increased decibels, it was viewed positively by participants, despite not objectively enhancing performance. Increased temperature was associated with less comfort, but not reduced technical or cognitive performance. Increased illumination reduced tiredness in some participants.

CONCLUSION: Noise consistently exceeds recommended thresholds, is linked to increased cognitive load, and has been associated with complications. In contrast, temperature is individual-specific and may require compromise between team members. There is very limited research on lighting and humidity, and more investigation is warranted before conclusions can be made on these factors. Surgeons should consider modifiable environmental factors as part of a systems approach to optimising operative performance, patient safety, and staff-wellbeing.