World Journal of Surgery

, Volume 43, Issue 1, pp 143–148 | Cite as

Cognitive Assessment of Surgeons During Surgical Procedures: Influence of Time and Intraoperative Complications

  • Juliana Beneduzzi
  • Fernando A. M. HerbellaEmail author
  • Francisco Schlottmann
  • Marco G. Patti
Original Scientific Report



Surgeon’s performance may be influenced by several factors that may affect skills and judgement, which ultimately represents surgeon´s cognition. Cognition refers to all forms of knowing and awareness, such as perceiving, conceiving, remembering, reasoning, judging, imagining, and problem solving. This report aims to evaluate the effect of operative time and operative complications on surgeon´s cognition.


Forty-six surgeons (mean age 31 years, 78% males) assigned to an operation expected to last for at least 2 h, volunteered for the study. All participants underwent 3 cognitive tests at the beginning of the operation and hourly, until the end of the procedure: (a) concentration (serial sevens, counting down from 100 by sevens); (b) visual (fast counting, counting the number of circles with the same color among a series of circles); and (c) motor (trail making, connecting a set of numbered dots). Intraoperative complications were recorded.


The visual test had a stable behavior along time. Concentration and motor tests tend to be performed faster. Intraoperative complications occurred in 5 (11%) cases (3 hemorrhage and 2 organ injuries). Performance time was stable for concentration and motor tests but visual test tends to be performed faster in cases with an intraoperative complication.


Our results showed that (1) time does not jeopardize surgeons’ cognition, but rather surgeons learned to perform the tests faster, and (2) complications do not decrease surgeons’ cognition.


Authors’ contribution

JB contributed to protocol/project development; data collection or management; data analysis; and manuscript writing/editing. FAMH involved in protocol/project development; data collection or management; data analysis; and manuscript writing/editing. FS and MGP performed manuscript writing/editing.

Compliance with ethical standards

Conflict of interest

There are no conflicts of interest to report.


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Juliana Beneduzzi
    • 1
  • Fernando A. M. Herbella
    • 1
    Email author
  • Francisco Schlottmann
    • 2
  • Marco G. Patti
    • 2
  1. 1.Department of SurgeryEscola Paulista de MedicinaSão PauloBrazil
  2. 2.University of North Carolina at Chapel HillChapel HillUSA

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