Patient-matched implants (PMIs) enable precise anatomical reconstruction but often introduce unforeseen intraoperative challenges that can provoke stress, reduce frustration tolerance, and influence surgical decision-making. Despite the growing clinical use of PMIs, the behavioural and psychological dimensions underpinning these challenging surgeries remain underexplored. This study examined the relationship between surgeon temperament, specifically frustration tolerance threshold, patience, and adherence to planned surgical workflows during PMI procedures. A qualitative thematic study was conducted over 22 months across two academic centres and 86 private surgical practices in South Africa. Data were collected through semi-structured interviews with consultant surgeons, assistant surgeons, surgical technologists, and biomedical engineers, supplemented by direct observation and detailed field notes. Inductive content analysis, thematic coding, and descriptive quantitative trends derived from Likert-style questionnaires were used to identify behavioural patterns associated with intraoperative stress and workflow deviation. Participant reports indicated that low frustration tolerance, often expressed as impatience, was perceived to be linked to increased deviations from surgical plans, including implant modification (reported in 4.6% of the 86 practices), even when design and fit were optimal. In 2.3% of the 86 practices surveyed, surgical team members reported incidents where impatience was perceived to have compromised patient safety. Stress inoculation theory and emotional intelligence frameworks offered explanatory models for the observed behaviours. Within the limits of this exploratory qualitative study, surgeon temperament—particularly mental preparedness and frustration tolerance—emerged as a recurring theme associated with intraoperative PMI workflow adherence. Whether these factors are determinants of workflow adherence whilst using high-fidelity PMIs, or merely correlated with other unmeasured variables, remains to be tested in future quantitative research.
Layton Vosloo (Wed,) studied this question.