NASA-TLX Assessment of Surgeon Workload Variation across Specialties

Bethany R. Lowndes, Katherine L. Forsyth, Renaldo C. Blocker, Patrick G. Dean, Mark J. Truty, Stephanie F. Heller, Shanda Blackmon, M. Susan Hallbeck, Heidi Nelson

Research output: Contribution to journalArticlepeer-review

90 Scopus citations


Objective:With advancements in surgical equipment and procedures, human-system interactions in operating rooms affect surgeon workload and performance. Workload was measured across surgical specialties using surveys to identify potential predictors of high workload for future performance improvement.Summary Background Data:Surgical instrumentation and technique advancements have implications for surgeon workload and human-systems interactions. To understand and improve the interaction of components in the work system, NASA-Task Load Index can measure workload across various fields. Baseline workload measurements provide a broad overview of the field and identify areas most in need of improvement.Methods:Surgeons were administered a modified NASA-Task Load Index survey (0 = low, 20 = high) following each procedure. Patient and procedural factors were retrieved retrospectively.Results:Thirty-four surgeons (41% female) completed 662 surgery surveys (M = 14.85, SD = 7.94), of which 506 (76%) have associated patient and procedural data. Mental demand (M = 7.7, SD = 5.56), physical demand (M = 7.0, SD = 5.66), and effort (M = 7.8, SD = 5.77) were the highest rated workload subscales. Surgeons reported difficulty levels higher than expected for 22% of procedures, during which workload was significantly higher (P < 0.05) and procedural durations were significantly longer (P > 0.001). Surgeons reported poorer perceived performance during cases with unexpectedly high difficulty (P < 0.001).Conclusions:When procedural difficulty is greater than expected, there are negative implications for mental and physical demand that result in poorer perceived performance. Investigations are underway to identify patient and surgical variables associated with unexpected difficulty and high workload. Future efforts will focus on re-engineering the surgical planning process and procedural environment to optimize workload and performance for improved surgical care.

Original languageEnglish (US)
Pages (from-to)686-692
Number of pages7
JournalAnnals of surgery
Issue number4
StatePublished - Apr 1 2020
Externally publishedYes


  • expected difficulty
  • human factors
  • human-systems interactions
  • mental demand
  • physical demand
  • surgical performance

ASJC Scopus subject areas

  • Surgery


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