K. E. Law1,2, B. R. Lowndes1,2,3, S. R. Kelley4, R. C. Blocker1,2, D. W. Larson4, M. Hallbeck1,2,4, H. Nelson4 1Mayo Clinic,Health Sciences Research,Rochester, MN, USA 2Mayo Clinic,Kern Center For The Science Of Health Care Delivery,Rochester, MN, USA 3Nebraska Medical Center,Neurological Sciences,Omaha, NE, USA 4Mayo Clinic,Surgery,Rochester, MN, USA
Introduction: Surgical techniques and technology are continually advancing, making it crucial to understand potential contributors to surgeon workload. Our goal was to measure surgeon workload in abdominopelvic colon and rectal procedures and attribute possible contributors.
Methods: Between February and April 2018, following each surgical case surgeons were asked to complete a modified NASA-Task Load Index (NASA-TLX) which included questions on distractions, fatigue, procedural difficulty, and expectation in addition to the validated NASA-TLX questions. All but the expectation question were rated on a 20-point scale (0=low, 20=high). Expectation was rated on a 3-point scale (i.e., more difficult than expected, as expected, less difficult than expected). Patient and procedural data were analyzed for procedures with completed surveys. Surgical approach was categorized as open, laparoscopic, or robotic.
Results: Seven surgeons (3 female) rated 122 procedures over the research period using the modified NASA-TLX survey. Across the subscales, mean surgeon-reported workload was highest for effort (M=10.83, SD=5.66) followed by mental demand (M=10.18, SD=5.17), and physical demand (M=9.19, SD=5.60). Procedures were rated moderately difficult (M=10.74, SD=5.58). There was no significant difference in procedural difficulty or fatigue by surgical approach.
Fifty-four percent (n=66) of cases were rated as meeting expected difficulty, with 35% (n=43) considered more difficult than expected. Mean surgeon-reported procedural difficulty aligned with expectation with a mean procedural difficulty level of 9.29 (SD=5.11) for as expected, 14.39 (SD=4.49) for more difficult than expected, and 5.92 (SD=4.15) for less difficult than expected (F(2,118)=21.89, p<0.001). Surgeons also reported significantly more fatigue for procedures considered more difficult than expected (F(2,118)=8.13, p<0.001) compared to procedures less difficult than expected.
Self-reported mental demand (r=0.88, p<0.001), physical demand (r=0.87, p<0.001), effort (r=0.90, p<0.001), and surgeon fatigue (r=.71, p<0.001) were strongly correlated with procedural difficulty. Furthermore, fatigue was strongly correlated with overall workload and the NASA-TLX subscales (r>0.7, p<0.001). Surgeons most frequently reported patient anatomy and body habitus, unexpected adhesions, and unfamiliar team members as contributors to ease or difficulty of cases.
Conclusion: Self-reported mental demand, physical demand, and effort were strongly correlated with procedural difficulty and surgeon fatigue. Surgeons attributed case ease or difficulty levels to patient and intraoperative factors; however, procedural difficulty did not differ across surgical approach. Understanding contributors to surgical workload, especially unexpectedly difficult cases, can help define ways to decrease workload.