This systematic review explores the impact of operating room organization on surgical performance and patient outcomes. The study, conducted according to PRISMA guidelines, identified 76 eligible studies from 2000 to 2019, focusing on five determinants (team composition, stability, teamwork, work scheduling, and disturbing elements) and three outcomes (operative time, patient safety, and costs). Key findings include: - **Team Composition**: Experienced surgeons and anesthesiologists reduced operative time and morbidity rates, while resident involvement increased morbidity and costs. - **Team Stability**: Stable surgical teams improved outcomes by reducing operative time, costs, and postoperative morbidity. - **Teamwork**: Enhanced teamwork reduced operative time and morbidity, while poor teamwork increased morbidity and costs. - **Work Scheduling**: Dedicated operating rooms and appropriate scheduling reduced morbidity, operative time, and costs. - **Disturbing Elements**: Disturbances negatively affected operative time and surgical safety. The review highlights the importance of specialized and stable teams, optimized teamwork, and efficient scheduling in improving surgical performance and patient outcomes. However, the literature is limited and of varying quality, with a need for further prospective studies to explore the broader range of organizational factors.This systematic review explores the impact of operating room organization on surgical performance and patient outcomes. The study, conducted according to PRISMA guidelines, identified 76 eligible studies from 2000 to 2019, focusing on five determinants (team composition, stability, teamwork, work scheduling, and disturbing elements) and three outcomes (operative time, patient safety, and costs). Key findings include: - **Team Composition**: Experienced surgeons and anesthesiologists reduced operative time and morbidity rates, while resident involvement increased morbidity and costs. - **Team Stability**: Stable surgical teams improved outcomes by reducing operative time, costs, and postoperative morbidity. - **Teamwork**: Enhanced teamwork reduced operative time and morbidity, while poor teamwork increased morbidity and costs. - **Work Scheduling**: Dedicated operating rooms and appropriate scheduling reduced morbidity, operative time, and costs. - **Disturbing Elements**: Disturbances negatively affected operative time and surgical safety. The review highlights the importance of specialized and stable teams, optimized teamwork, and efficient scheduling in improving surgical performance and patient outcomes. However, the literature is limited and of varying quality, with a need for further prospective studies to explore the broader range of organizational factors.