NASA-Task Load Index Differentiates Surgical Approach

Abstract

Objective: Surgeon workload, or human “cost” of performing a procedure, is not well understood in light of emerging surgical technologies. This pilot study quantified surgeon workload for colorectal procedures and identified patient, surgeon, and procedural factors impacting workload. Summary Background Data: Innovative technologies and procedures in surgery have generally been promoted for the advancement of patient care. The resulting surgeon workload is poorly studied with little knowledge of the contributing factors impacting workload. Methods: Surgeons completed NASA-Task Load Index (NASA-TLX) questionnaires to self-assess workload following abdominopelvic colon and rectal procedures. Corresponding patient data were retrieved from the medical record. Descriptive statistics, correlations, and ANOVA were performed to compare surgeon and patient factors, procedure type, and surgical approach on workload overall and by subscales. Results: Seven attending surgeons rated 238 surgeries, of which 218 (92%) had corresponding patient data. Surgeon experience and patient demographics had inconsistent effects on workload. A statistically significant 3-way interaction was identified among disease process, procedure type, and surgical approach on workload (F(9, 146) = 2.17, P = 0.027), but was limited to open procedures for neoplasia and inflammatory bowel disease patients. Proctectomy and colectomy procedures compared across open, laparoscopic, and robotic approaches showed significant differences in overall workload and subscales, where the robotic procedures required significantly less mental demand, physical demand, and effort, than open or laparoscopic (P < 0.05). Conclusions: Patient characteristics, disease process, and surgical experience had inconsistent effects on surgeon workload. Major differences in workload were identified for procedure type and surgical approach, where robotic procedures required less mental demand, physical demand, and effort.

Surgeon Workload in Colorectal Surgery: Perceived Drivers of Procedural Difficulty

“…Surgeons more often experience challenges such as visceral obesity, adhesions, and a narrow pelvic working space during colectomy and proctectomy procedures that are not often experienced during anorectal or other procedures such as colostomy or ileostomy creation. Furthermore, previous work has shown surgeon workload during proctectomy and colectomy procedures commonly exceed the midpoint threshold (i.e., 50 out of 100), 12 which may be indicative of the overall difficulty level identified by participants in the current study. Surgeons however did not report a significant difference in procedural difficulty according to their experience level.…”

“…Participants were asked to complete a questionnaire within 24 h of each surgical procedure. The questionnaire consisted of the workload items from the original NASA-TLX 11,12 but was modified to include additional questions targeted at the drivers contributing to procedural ease or difficulty. No alterations were made to the original NASA-TLX questionnaire.…”

“…A question on variation from expected procedural difficulty was also included and was reported as "expected," "less difficult than expected," or "more difficult than expected." 11 As a result of findings in our previous work on colorectal workload, 12 additional questions regarding drivers of workload were included. The driver questions included items on patient factors (e.g., anatomy, cancer, adhesions, previous surgery, and BMI), teaming (e.g., teamwork quality, team familiarity, multiple teams, and trainees), personal factors (e.g., on-call/post-call, other), and equipment (e.g., lack thereof, malfunction).…”

“…Further analysis on the implications of surgical approach and patient factors on surgeon workload can be found elsewhere. 11,12 Across all of the collected procedures, surgeons rated them moderately difficult (M ¼ 10.7, SD ¼ 5.6). There was no significant difference in procedural difficulty according to surgical experience or by surgical approach (Table 3); however, the percentage of cases rated more difficult (i.e., 10) varied.…”

“…6,7 In the past decade, NASA-TLX has gained traction in healthcare and more specifically, surgery. [8][9][10][11][12][13] The NASA-TLX instrument consists of six subscales that represent different aspects of workload: mental demand (MD), physical demand (PD), temporal demand (TD), effort (Ef), performance (Pe), and frustration (Fr). In surgery, it has raised concern over high workload experienced in the operating room 14,15 and has been linked to declining surgical Pe.…”