BackgroundStress has been shown to impact adversely on multiple facets critical to optimal performance. Advancements in wearable technology can reduce barriers to observing stress during surgery. This study aimed to investigate the association between acute intraoperative mental stress and technical surgical performance.MethodsContinuous electrocardiogram data for a single attending surgeon were captured during surgical procedures to obtain heart rate variability (HRV) measures that were used as a proxy for acute mental stress. Two different measures were used: root mean square of successive differences (RMSSD) and standard deviation of RR intervals (SDNN). Technical surgical performance was assessed on the Operating Room Black Box® platform using the Generic Error Rating Tool (GERT). Both HRV recording and procedure video recording were time‐stamped. Surgical procedures were fragmented to non‐overlapping intervals of 1, 2 and 5 min, and subjected to data analysis. An event was defined as any deviation that caused injury to the patient or posed a risk of harm.ResultsRates of events were significantly higher (47–66 per cent higher) in the higher stress quantiles than in the lower stress quantiles for all measured interval lengths using both proxy measures for acute mental stress. The strongest association was observed using 1‐min intervals with RMSSD as the HRV measure (P < 0·001).ConclusionThere is an association between measures of acute mental stress and worse technical surgical performance. Further study will help delineate the interdependence of these variables and identify triggers for increased stress levels to improve surgical safety.

Wearable technology is an emerging manifestation of consumer electronics that has the potential to revolutionise healthcare. The novel hands-free design and clinically relevant functionalities of various wearable devices hold significant promise for surgery, but the breadth and quality of evidence supporting clinical implementation in the operating room remains unclear. The objective of this article is to provide an objective overview of the available literature regarding the use of wearable technology in surgery, both in clinical and simulated experimental settings. A systematic review examining the use of wearable technology in surgery was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines using the MEDLINE and Web of Science databases from inception through 15 January 2016. Three authors independently screened the titles and abstracts of the retrieved articles and those that satisfied the defined inclusion criteria were selected for a full-text review. A total of 87 publications were included in this review. These articles predominantly described the use of Google Glass, GoPro or customised head-mounted displays (HMDs) in a wide range of intraoperative clinical settings. The included articles were categorised based on the highlighted areas of clinical impact, with the majority (56) discussing various applications for enhancing intraoperative safety and efficiency. Almost all articles cited technological limitations and privacy concerns as serious barriers to the implementation of wearable technology in the operating room. Evidence in the available literature regarding the use of wearable technology in the operating room shows promise, but high-quality clinical trials are needed to fully understand their clinical impact. Further, it will be essential to address existing technological limitations, develop healthcare-specific applications, and integrate privacy-protecting safeguards before it may be feasible for wearable devices to seamlessly integrate into the operative environment.

Background Studies have demonstrated that surgical safety checklists (SSCs) can significantly reduce surgical complications and mortality rates. Such lists rely on traditional posters or paper, and their contents are generic regarding the type of surgery being performed. SSC completion rates and uniformity of content have been reported as modest and widely variable. Objective This study aimed to investigate the feasibility and potential of using smart glasses in the operating room to increase the benefits of SSCs by improving usability through contextualized content and, ideally, resulting in improved completion rates. Methods We prospectively evaluated and compared 80 preoperative time-out events with SSCs at a major academic medical center between June 2016 and February 2017. Participants were assigned to either a conventional checklist approach (poster, memory, or both) or a smart glasses app running on Google Glass. Results Four different surgeons conducted 41 checklists using conventional methods (ie, memory or poster) and 39 using the smart glasses app. The average checklist completion rate using conventional methods was 76%. Smart glasses allowed a completion rate of up to 100% with a decrease in average checklist duration of 18%. Conclusions Compared with alternatives such as posters, paper, and memory, smart glasses checklists are easier to use and follow. The glasses allowed surgeons to use contextualized time-out checklists, which increased the completion rate to 100% and reduced the checklist execution time and time required to prepare the equipment during surgical cases.

There is a profound lack of awareness of SUD reprocessing and reuse among all relevant stakeholders. In addition, the overwhelming desire for transparency among patients further forces the debate of whether current, covert methods should be altered, in addition to the question of who bears this responsibility. Despite research and history having shown the practice to be safe, apprehension and misconceptions remain. Survey results suggest that education may be able to subdue such patient concerns.