title: Psychophysical workload in the operating room: primary surgeon versus assistant.
abstract: BACKGROUND
  Working in the operating room is characterized by high demands and overall workload of the surgical team. Surgeons often report that they feel more stressed when operating as a primary surgeon than in the function as an assistant which has been confirmed in recent studies. In this study, intra-individual workload was assessed in both intraoperative functions using a multidimensional approach that combined objective and subjective measures in a realistic work setting.
  
  
  METHODS
  Surgeons' intraoperative psychophysiologic workload was assessed through a mobile health system. 25 surgeons agreed to take part in the 24-hour monitoring by giving their written informed consent. The mobile health system contained a sensor electronic module integrated in a chest belt and measuring physiological parameters such as heart rate (HR), breathing rate (BR), and skin temperature. Subjective workload was assessed pre- and postoperatively using an electronic version of the NASA-TLX on a smartphone. The smartphone served as a communication unit and transferred objective and subjective measures to a communication server where data were stored and analyzed.
  
  
  RESULTS
  Working as a primary surgeon did not result in higher workload. Neither NASA-TLX ratings nor physiological workload indicators were related to intraoperative function. In contrast, length of surgeries had a significant impact on intraoperative physical demands (p < 0.05; η(2) = 0.283), temporal demands (p < 0.05; η(2) = 0.260), effort (p < 0.05; η(2) = 0.287), and NASA-TLX sum score (p < 0.01; η(2) = 0.287).
  
  
  CONCLUSIONS
  Intra-individual workload differences do not relate to intraoperative role of surgeons when length of surgery is considered as covariate. An intelligent operating management that considers the length of surgeries by implementing short breaks could contribute to the optimization of intraoperative workload and the preservation of surgeons' health, respectively. The value of mobile health systems for continuous psychophysiologic workload assessment was shown.
authors.affiliation: Institute for Preventive Medicine, Rostock University Medical Center, Rostock, Germany, annika.rieger@uni-rostock.de.
authors.forename: Annika
authors.initials: A
authors.lastname: Rieger
authors.forename: Sebastian
authors.initials: S
authors.lastname: Fenger
authors.forename: Sebastian
authors.initials: S
authors.lastname: Neubert
authors.forename: Matthias
authors.initials: M
authors.lastname: Weippert
authors.forename: Steffi
authors.initials: S
authors.lastname: Kreuzfeld
authors.forename: Regina
authors.initials: R
authors.lastname: Stoll
mesh_terms: D000328:Adult; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009873:Operating Rooms / Q000458:organization & administration*; D011446:Prospective Studies; D011601:Psychophysics; D056152:Respiratory Rate; D012881:Skin Temperature; D013312:Stress, Physiological / Q000502:physiology*; D013315:Stress, Psychological / Q000503:physiopathology*; D066231:Surgeons; D016526:Workload; D017132:Workplace