Optimizing Outcomes in Urologic Surgery: Intraoperative Environmental, Behavioral, and Performance Considerations

Introduction: Intraoperative surgical outcomes are influenced by a wide variety of environmental, provider and institutional factors. There is little in the current literature that provides guidance for practitioners interested in adapting these factors to improve the quality of the urological care they provide. Methods: A multidisciplinary panel of subject matter experts (urologists, nurses, anesthesiologists) was convened to evaluate the existing literature, create a white paper, and disseminate this to providers and institutions to fuel quality improvement efforts in urological surgery. Focusing on intraoperative environmental, behavioral and performance factors, a narrative review was performed, highlighting practical interventions when available. Results: Intraoperative performance is optimized by encouraging a culture of safety, improving intraoperative teamwork, thoughtfully navigating conflict and disruptive behavior, improving surgeon ergonomics, minimizing noise/distractions and engaging in ongoing technical performance improvement. In addition, practical tools are provided to assist in the challenging task of quality improvement in the surgical context. Conclusions: We summarize the influence of organizational culture, environment and behavior on surgical performance and outcomes. This work is intended to support local quality improvement efforts by educating the urological community regarding less well-known environmental, behavioral and institutional factors that influence surgical performance and patient outcomes.