The Intraoperative Workload Assessment Using Surgery Taskload Index at University Teaching Hospital of Kigali, Rwanda

Abstract

Background: The complexity of the operating room can generate a high mental and physical workload demand for operating team. Complex surgical techniques and technologies are continually evolving, increasing the mental demands and physical demands to the surgeons and their teams. Objectives: This study aimed to assess the intra-operative workload of surgical care providers at the University Teaching Hospital of Kigali (CHUK). Methods: This was a prospective cohort study. 39 surgical care providers have been followed performing 120 surgical procedures over the period of 3 months. The surgery task load index (TLX) tool was used to collect data on the six dimensions for surgery workload assessment: Mental demands, physical demands, temporal demands, task complexity, situational stress, and distractions. SPSS version 22 was used for data analysis. Percentages and means have been used for descriptive statistics. For categorical variables with comparison groups not exceeding 2, Fischer’s exact test was used; otherwise, chi-square test was used. A p –value of 0.05 or less was considered statistically significant. Odds ratio (OR) and 95% confidence interval (CI) was estimated using logistic regression analysis.

Results: 120 operative cases and 39 surgical care providers were included, 26 residents /fellows and 13 surgeons. Most surgical procedures were open technique (85%). 71% of surgical care providers had high intra-operative workload above midpoint of SURG-TLX scale, indicating high unsustainable high workload. Surgeons also surpassed midpoint on SURG-TLX subscale in 47.5% for mental demand, 37.5% for physical demand, 42.5% for temporal demand, 44.17% for task complexity, 32.5% for situational stress and 25.83% for distraction. Factors influencing intra-operative workload were duration of procedure (p=0.017) and surgeon experience (p=0.003). No statistically significant difference of intra-operative workload among different surgical specialties.

Conclusion: The majority of surgical care providers experienced high level of intra-operative workload at unsustainable level. Factors influencing intra-operative workload were procedure duration and surgeons experience. We would recommend introducing in-theater stress management program, targeted stretching micro-breaks to improve mental wellbeing of surgical providers.