Summary of the study

Rationale: Although recent efforts have been made to improve patient care and safety before, during, and after surgery, the factors that contribute to surgical complications are not well understood. Past research has mainly focused on  factors related to the patient or the patient’s care. However, a patient’s risk of experiencing postoperative complications also depends on the interaction, on any given day, between the surgeon, the team, and the organization of the surgical theatre. The surgeon’s performance during the operation is a key determinant of the success of the surgery. Therefore, solutions that optimize the surgeon’s condition at the time of surgery could promote high-quality surgical care. We aim to study this aspect of surgery in real time, and in close collaboration with the surgical teams, using an approach inspired by previous research in non-health-related fields.

Objectives: This surgeon-centred study has three successive goals: 1- Identify the key factors related to the surgeon’s personal condition or the operating room environment that influence his/her performance in terms of patient morbidity/mortality and operation duration; 2- Develop a customized coaching program for surgeons based on the human and organizational factors identified during the first phase of the study. The program will provide individualized coaching and training modules to improve performance. The participants’ surgical performance will be tracked over the course of the intervention; 3- Measure the impact of this program on surgical outcomes in a group of randomly selected surgeons compared to a control a group of surgeons who were not exposed to the intervention.

Methods: A prospective multicentre cluster randomized trial will be conducted in the adult digestive, orthopaedic, gynaecological, urological, cardiac and thoracic surgery departments of several university hospitals. A cohort of surgeons (clusters) will be established and monitored during an observation period, which will be used to collect data on the operating theatre environment, the  surgeons’ individual parameters, and the patient outcomes. These data will come from the hospitals’ data system, sensors worn by surgeons, and self-administered questionnaires. These data will be analysed to identify the human and organizational factors associated with the surgeon’s performance (the main criterion will be patient morbidity and mortality within 30 days of the surgical intervention), and to develop a coaching program adapted to the needs and preferences of the surgeons. This program will then be evaluated experimentally during an intervention period. Surgeons will be randomly assigned to either the treatment or control arms of the trial. Customised coaching will be implemented for surgeons assigned to the intervention arm, while no specific action will be undertaken for surgeons assigned to the control arm.

Perspectives: Our study aims to improve our understanding of the human and organizational determinants that can influence surgeons’ results over time, regardless of the patient’s preoperative risk and the complexity of the surgical procedure. Ultimately, we hope to identify factors that can optimize the surgeons’ performance. Solutions to control these factors will be tested to establish standards of surgical practice based on scientific evidence.

Study register: The study is registered at ClinicalTrials provided by the U.S. National Library of Medicine.