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Assessing Cognitive Workload and Performance in the Operating Room: Challenges in Applying NASA-TLX Among Experienced

Yit J Leang1,2, Stephen W Bell1,3, Kaleb R Lourensz1,2

  • 1Department of Surgery, School of Translational Medicine, Monash University, Alfred Health, Melbourne, Victoria, Australia.

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Summary
This summary is machine-generated.

This pilot study found that the NASA Task Load Index (NASA-TLX) can assess cognitive workload (CWL) in live surgery. However, no significant correlation was found between CWL and surgical performance in expert surgeons.

Keywords:
NASA‐TLXcognitive workloadsurgical executionsurgical performance

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Area of Science:

  • Surgical Performance and Cognitive Workload
  • Operative Outcomes
  • Minimally Invasive Surgery

Background:

  • Surgical performance and cognitive workload (CWL) are critical for operative outcomes.
  • Previous research on CWL and surgical performance primarily used simulated environments, limiting clinical relevance.
  • This study pilot-tested the NASA Task Load Index (NASA-TLX) for measuring CWL in actual operating theaters.

Purpose of the Study:

  • To evaluate the feasibility of using NASA-TLX to measure task-related CWL in operating theaters.
  • To investigate the relationship between CWL and technical surgical performance.
  • To utilize validated assessment tools for objective performance evaluation.

Main Methods:

  • A prospective, multicenter study involving five expert surgeons across seven Australian hospitals.
  • 61 minimally invasive surgeries (right hemicolectomies, secondary gastric bypasses) were performed.
  • Surgeons self-reported CWL using NASA-TLX, while technical performance was assessed using validated instruments (GOALS, GEARS, BOSATS).

Main Results:

  • Workload scores exhibited substantial variation within and across surgeons.
  • High overall surgical proficiency was observed, though seven cases had notable technical errors.
  • No strong correlation was identified between NASA-TLX scores and technical performance measures.

Conclusions:

  • The NASA-TLX is feasible for assessing CWL during live surgery and linking metrics to performance.
  • Significant inter-surgeon variability in both workload and proficiency was observed.
  • This study found no significant association between CWL and performance in expert surgeons.