Surgical interruptions and preventable delays in the operating rooms of academic teaching hospitals

Operating rooms are complex environments prone to delays and interruptions, which are linked to human error and adverse patient outcomes. Since more than half of the hospitals in Iran are teaching hospitals, understanding these delays and interruptions is crucial to prevent them. This observational study aimed to assess the lost time and causes for surgical interruptions and delays in Iranian academic teaching hospitals. This cross-sectional observational study was conducted in five teaching hospitals in Iran during July and August of 2025. A total of 251 surgeries were randomly observed using full-case non-participant observation. Data were collected using a chronometer and standardized forms. Causes of delays and interruptions were categorized through directed content analysis. Quantitative data were analyzed with statistical package for social science (SPSS) version 24. The primary outcome was total lost time per surgery. The secondary outcomes were frequency and duration of interruptions and delays, as well as the distribution of causes. Out of 50,675 observed minutes, 7,920 min (16.83%, Confidence Interval 95%: 14.62–19.04) were lost due to interruptions and delays. A total of 281 delays with 319 causes were recorded and classified into five categories: operating room staff (172 times), staff outside the operating room (21), instruments and devices (60), patients (33), and managerial issues (33). Notably, 14.1% of causes were related to the educational nature of the hospitals, involving residents and trainees. Surgical interruptions and delays happen frequently and may reduce operating room efficiency and threaten patient safety. Delays related to residents and trainees require further investigation considering overall operating room efficiency. Educational, managerial, and instrument-related interventions may reduce lost operating room time. The findings may be generalizable to academic teaching hospitals.