ORCHESTRA
Association Between Intraoperative Distractions, Surgeon Anxiety and Task Load, Team Collaboration, and Intraoperative Adverse Events: The ORCHESTRA Study
Sponsor study identifier
observational
400
1 country
1
Study Start
January 1, 2026
Actual (reported)Primary Completion
December 31, 2027
EstimatedPlanned date reported by the registry; this milestone is not confirmed as achieved.
Study Completion
December 31, 2027
EstimatedPlanned date reported by the registry; this milestone is not confirmed as achieved.
During surgery, telephone calls, conversations, equipment problems and other events may distract the operating team. Some events interrupt the progress of the operation. The surgeon's workload and anxiety, together with how well the team works together, may also be related to events that occur during surgery. ORCHESTRA is an observational study of patients undergoing colorectal or anal surgery in a single hospital. Trained observers record distractions during routine operations. After each operation, the surgeon reports workload and anxiety, and an observer assesses teamwork. Intraoperative adverse events are graded using a standard severity classification. The study examines how these measurements are related. It does not assign treatments, introduce distractions or change routine surgical care.
Registry-reported information. Elapsed time and enrollment totals alone do not measure study progress or recruitment pace.
December 31, 2027
EstimatedPlanned date reported by the registry; this milestone is not confirmed as achieved.
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Dates and qualifiers reported by the registry. Estimated dates do not confirm that a milestone has occurred.
January 1, 2026
Actual (reported)October 8, 2026
Actual (reported)October 14, 2026
Actual (reported)December 31, 2027
EstimatedPlanned date reported by the registry; this milestone is not confirmed as achieved.
December 31, 2027
EstimatedPlanned date reported by the registry; this milestone is not confirmed as achieved.
Intraoperative adverse-event severity assessed by ClassIntra
The highest ClassIntra grade recorded during the index operation. Grade 0 indicates no intraoperative adverse event; grades I through V indicate increasing severity, with grade V indicating intraoperative death. The case-level ordinal score is analysed in relation to distraction burden and other recorded patient, procedural and human-factor measurements.
During the index operation, from anaesthetic induction to extubation
ClassIntra grade II or higher intraoperative adverse event
During the index operation, from anaesthetic induction to extubation
Surgeon state-anxiety score
Immediately after completion of the index operation
Consecutive eligible patients undergoing colorectal or anal surgery performed by the designated surgeon in the participating unit. Naturally occurring distractions, surgeon workload and anxiety, team collaboration and intraoperative adverse events are assessed during the index operation.
Observational recording of naturally occurring distractions and assessment of surgeon workload, situational anxiety and team collaboration during routine surgical care. No experimental exposure is assigned and no change to treatment is prescribed.
Registry-reported names are shown in full. Names without a link have not yet been matched to a Syfrah profile.
Consecutive eligible adult patients undergoing colorectal or anal surgery in the participating unit, performed by the designated surgeon during the study period.
Ippokrateio Hospital
Athens, Greece
Dell-Kuster S, Gomes NV, Gawria L, Aghlmandi S, Aduse-Poku M, Bissett I, Blanc C, Brandt C, Ten Broek RB, Bruppacher HR, Clancy C, Delrio P, Espin E, Galanos-Demiris K, Gecim IE, Ghaffari S, Gie O, Goebel B, Hahnloser D, Herbst F, Ioannidis O, Joller S, Kang S, Martin R, Mayr J, Meier S, Murugesan J, Nally D, Ozcelik M, Pace U, Passeri M, Rabanser S, Ranter B, Rega D, Ridgway PF, Rosman C, Schmid R, Schumacher P, Solis-Pena A, Villarino L, Vrochides D, Engel A, O'Grady G, Loveday B, Steiner LA, Van Goor H, Bucher HC, Clavien PA, Kirchhoff P, Rosenthal R. Prospective validation of classification of intraoperative adverse events (ClassIntra): international, multicentre cohort study. BMJ. 2020 Aug 25;370:m2917. doi: 10.1136/bmj.m2917.
Wilson MR, Poolton JM, Malhotra N, Ngo K, Bright E, Masters RS. Development and validation of a surgical workload measure: the surgery task load index (SURG-TLX). World J Surg. 2011 Sep;35(9):1961-9. doi: 10.1007/s00268-011-1141-4.
Nikolaos Ntanos
National and Kapodistrian University of Athens
George Theodoropoulos
National and Kapodistrian University of Athens
First Submitted
October 8, 2026
First Posted
October 14, 2026
Study Start
January 1, 2026
Actual (reported)Primary Completion
December 31, 2027
EstimatedSurgeon task-load score
Immediately after completion of the index operation
Observer-rated team collaboration score
Immediately after completion of the index operation
C-class distraction count
During the index operation, from anaesthetic induction to extubation
Contact the study team to confirm eligibility.
Undre S, Sevdalis N, Healey AN, Darzi A, Vincent CA. Observational teamwork assessment for surgery (OTAS): refinement and application in urological surgery. World J Surg. 2007 Jul;31(7):1373-81. doi: 10.1007/s00268-007-9053-z.
Hull L, Arora S, Kassab E, Kneebone R, Sevdalis N. Observational teamwork assessment for surgery: content validation and tool refinement. J Am Coll Surg. 2011 Feb;212(2):234-243.e1-5. doi: 10.1016/j.jamcollsurg.2010.11.001.
Wheelock A, Suliman A, Wharton R, Babu ED, Hull L, Vincent C, Sevdalis N, Arora S. The Impact of Operating Room Distractions on Stress, Workload, and Teamwork. Ann Surg. 2015 Jun;261(6):1079-84. doi: 10.1097/SLA.0000000000001051.
Keogh S, Laski D. A Concern for Intraoperative Distractions and Interference: An Observational Study Identifying, Measuring, and Quantifying Both within the Operating Theatre. Surg Res Pract. 2021 Dec 11;2021:9910290. doi: 10.1155/2021/9910290. eCollection 2021.
Ntanos N, Dimakakou K, Pantermaraki M, Filis K, Sigala F, Theodorou D, Chamzin A, Galyfos G. Evaluating Intraoperative Distractions During Surgical Procedures in a University Surgical Department-A Quantitative Analysis. World J Surg. 2025 Dec;49(12):3444-3447. doi: 10.1002/wjs.70174. Epub 2025 Nov 20.
Planned date reported by the registry; this milestone is not confirmed as achieved.
Study Completion
December 31, 2027
EstimatedPlanned date reported by the registry; this milestone is not confirmed as achieved.
Last Updated
October 21, 2026
Record last verified: 2026-10
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