Excessive mental workload may affect surgical performance and patient safety, and wearable devices and other physiological monitoring could help researchers measure it, according to an article in the fall 2026 issue of Vertebral Columns. Measuring it in the operating room remains difficult, the authors said.
Four authors from the orthopedics department at New York City-based Hospital for Special Surgery wrote the article, including Takayuki Kobayashi, MD, and Sravisht Iyer, MD. They reviewed how mental workload is defined and measured and what it could mean for surgical performance, physician well-being and patient safety.
Five things to know:
1. Mental workload cannot be observed directly. The authors said there is no universally accepted definition or single measure of it. Excessive workload may also hurt surgical performance, so measuring it could matter for patient safety as well as surgeon well-being.
2. Wearables allow continuous monitoring. Chest straps, wrist-worn sensors and other devices can track heart rate and heart rate variability throughout a procedure. The authors said that makes them attractive for studying surgical workload, but the signals reflect autonomic nervous system activity, not workload itself.
3. Combining signals worked better in simulation. Combinations of cardiac and ocular measures predicted workload and performance better than single measures in simulation studies, and so did models that blended brain activity, heart rate variability, electrodermal activity and motion. The authors said the findings need validation in real operating rooms.
4. The operating room muddies the signals. Motion, electrocautery and power tools can interfere with sensors. Exertion, emotional arousal, caffeine, medications, sleep and factors such as a prior night on call can also change physiological signals without any change in mental workload. The authors said study design must account for this through baseline measurements and synchronization with perioperative events.
5. New surgical technology adds urgency, but no standard exists. The authors said robotics, navigation and augmented reality are changing how surgeons interact with information, and workload measures could evaluate those tools from the surgeon’s perspective. No standardized approach has been established, they said, and combining complementary measures and interpreting them in context will be essential.
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