The impact of noise in the operating theatre: A review of the evidence

Why does this study matter?
Apart from the obvious reason mentioned on the screen, the reason I am personally interested in this topic is because, my PhD deals with the design details of hybrid OR’s where there are different imaging equipment placed and the coming together of multiple teams, noise is always a challenge.
 
How was the study done and what did we learn?
The first literature review explored the effects of noise in the operating room and the perception toward music in the OR. The researchers conducted a thorough search across various databases and assessed the quality of the studies they found. In a nutshell, the review revealed that quieter surgeries tend to have fewer post-operative complications. On the flip side, high noise levels in the OR can be linked to an increased risk of surgical-site infections.

The noise in the operating room can also stress the surgical staff and affect their performance. It may not significantly impact laparoscopic tasks, but it does affect clinical reasoning, especially in less experienced anesthesiological residents. Communication is vital in the OR, and noise can disrupt it, causing distractions, particularly for surgeons.

Regarding the role of music in the OR, it's quite common during surgeries. Most surgical team members enjoy it and find it beneficial, as it can improve performance, reduce stress, and enhance teamwork. However, in critical moments, some people find it distracting, and it can occasionally hinder communication.

The second literature review delved into the impact of noise in the operating theater, emphasizing its influence on surgical team functioning and patient care. Effective verbal communication is essential in the OR to ensure patient and professional safety. It's known that communication breakdowns can lead to technical errors and adverse events in surgery.

Background noise, especially sudden loud peaks, can disrupt communication within the surgical team, affecting efficient workflow. This is more pronounced in junior surgical trainees. Noise peaks also increase distractions among surgeons during critical phases of a procedure and can lead to undue stress. Additionally, excessive noise has been associated with surgical site infections, underlining the need for noise reduction during surgeries.

It's not just background noise; the volume of speech in the theater matters. To communicate effectively in a noisy environment, speech needs to be significantly louder than the background noise. Failure to do so can lead to compromised patient safety.

The review also highlighted that noise can lead to errors and reduced dexterity, particularly among trainee surgeons during simulated laparoscopic tasks. Experienced surgeons seem to adapt to the noise over time. Furthermore, small talk and case-irrelevant verbal communication in the OR can negatively impact the quality of care and the surgeon's experience.
Now, let's shift our focus to the clinical trial. The aim here was to investigate whether a visual noise warning device could make surgeries quieter, reduce surgeon stress, and potentially benefit patients. The trial took place in a hospital that performs a substantial number of surgeries each year.

The trial utilized a device called SoundEar 2 to measure and display the noise level in the OR. It employed a color-coded system to indicate noise levels. In the study, patients underwent surgery with or without noise measurements, and the trial had two phases.

While they couldn't use data from some surgeries due to incomplete noise measurements, they found that using the device reduced the average noise level during surgery. Shorter surgeries tended to be noisier than longer ones, and complex surgeries were somewhat quieter. Interestingly, the type of surgery and the surgeon's experience didn't have a significant impact.

When it comes to the connection between noise and clinical outcomes, quieter surgeries generally had fewer complications. Slightly higher noise levels were associated with a small increase in the risk of post-surgery death. However, the loudest noise during surgery didn't make a substantial difference.
 
Can we say the results are definitive?
In conclusion, these findings highlight the importance of addressing noise in the operating room. It can impact both patient outcomes and the well-being of the surgical team. However, it's essential to acknowledge that many of the studies were observational, making it challenging to establish direct cause-and-effect relationships.

As for the clinical trial, it's worth noting that the results may not be universally applicable, as it was conducted in a single center. Additionally, the study did not investigate specific noise sources in the operating room, which could have provided valuable insights. There were some limitations in data collection, and staff reservations about the noise-monitoring system might have influenced the study's results.
 
What’s the takeaway?
One of the key takeaways from these findings is actually quite ironic where the noise problem can be addressed through visual solutions. Visual noise barrier devices can be an integrated design element within the OR. Additionally, it is essential that more research is conducted on ways to address the noise in the OR. That's a brief overview of the key findings from these reviews and the clinical trial.
 
Summary of:

Mcleod, R., Myint-Wilks, L., Davies, S., & Elhassan, H. (2021). The impact of noise in the operating theatre: A review of the evidence. The Annals of The Royal College of Surgeons of England, Issue 2, Volume 103, Page(s) 83–87. https://doi.org/10.1308/rcsann.2020.7001
 

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