Authors : Kawu Ahidjo Abdulkadiri

Volume/Issue : Volume 11 - 2026, Issue 4 - April

Google Scholar : https://tinyurl.com/539nzjkm

Scribd : https://tinyurl.com/3ahp7tep

DOI : https://doi.org/10.38124/ijisrt/26apr879

Note : A published paper may take 4-5 working days from the publication date to appear in PlumX Metrics, Semantic Scholar, and ResearchGate.

Abstract : Background: Decision fatigue refers to the progressive deterioration in the quality of decisions after a prolonged period of decision‑making. Surgeons, who face high‑stakes, repetitive intraoperative choices, are particularly vulnerable. This study assessed the prevalence and perceived impact of decision fatigue among surgeons at the National Orthopaedic Hospital Dala (NOHD), Kano.  Methods: A descriptive cross‑sectional study was conducted among all 20 surgeons (4 spine surgeons, 16 orthopaedic surgeons) at NOHD between January and March 2026. A structured, self‑administered questionnaire assessed awareness of decision fatigue, intraoperative decision load, perceived decline in decision quality during prolonged lists, influence of time‑of‑day on judgment, and self‑attributed clinical errors or near‑misses. Responses were recorded on a 5‑point Likert scale (1=strongly disagree to 5=strongly agree). Data were analysed using descriptive statistics.  Results: All 20 surgeons (100% response) participated. Mean age was 44.8±8.2 years; all were male. Awareness of decision fatigue was high (90% agreed/strongly agreed). Intraoperative decision load was rated as very high by 80% of respondents. Decline in decision quality during the latter half of prolonged surgical lists was reported by 75%. Time‑of‑day influence on clinical judgment was acknowledged by 70%. Moreover, 60% attributed at least one clinical error or near‑miss to decision fatigue in the preceding 12 months. The mean overall perception score across domains was 4.1±0.7 (scale 1–5). Spine surgeons reported slightly higher scores than orthopaedic surgeons (4.3 vs 4.0, p>0.05).  Conclusion: Decision fatigue is highly prevalent among surgeons at NOHD Kano and is perceived to adversely affect clinical judgment and patient safety. Despite universal recognition of the problem, no institutional mitigation strategies exist. Structured breaks, workload distribution, and cognitive offloading strategies are urgently needed.

Keywords : Decision Fatigue, Surgeon Burnout, Patient Safety, Nigeria

References :

1. Ijaz M, Whiteway S. Does decision fatigue impact on surgical outcomes? – A scoping review. Br J Surg. 2024;111(Supplement_6). doi:10.1093/bjs/znae163.757
2. Lee A, Torkamani-Azar M, Zheng B, Bednarik R. Unpacking the broad landscape of intraoperative stressors for clinical personnel: a mixed-methods systematic review. J Multidiscip Healthc. 2023;16:1953-1977.
3. Whelehan DF. To survive or to thrive: an investigation into fatigue and associated factors on surgical performance. Doctoral dissertation. Trinity College Dublin; 2021.
4. Koda N, et al. Surgeon fatigue does not affect surgical outcomes: a systematic review and meta-analysis. Surg Today. 2021;51(5):659-668.
5. Persson E, Barrafrem K, Meunier A, Tinghög G. The effect of decision fatigue on surgeons' clinical decision making. Health Econ. 2019;28(10):1194-1203.
6. Systematic review of the effects of decision fatigue in healthcare professionals on medical decision-making. Health Psychol Rev. 2025;19(2):1-22.
7. Coker AO, Adewole OA, Shoga MO, Uzodimma CC. Burnout syndrome among orthopaedic surgeons in Lagos, Nigeria. East Cent Afr J Surg. 2012;17(2):13-17.
8. Hart SG, Staveland LE. Development of NASA-TLX (Task Load Index): results of empirical and theoretical research. Adv Psychol. 1988;52:139-183.
9. Wilson MR, Poolton JM, Malhotra N, Ngo K, Bright E, Masters RS. Development and validation of a surgical workload measure: the surgery task load index (SURG-TLX). World J Surg. 2011;35(9):1961-1969.
10. Arora S, Sevdalis N, Nestel D, Woloshynowych M, Darzi A, Kneebone R. The impact of stress on surgical performance: a systematic review of the literature. Surgery. 2010;147(3):318-330.
11. Flush model: a novel framework to manage surgeons’ mental fatigue and cognitive load. Ann Surg Open. 2025;6(2):e581.
12. Whelehan DF, Brown DJ. Fatigued surgeons: a thematic analysis of the causes, effects and opportunities for fatigue mitigation in surgery. Br J Surg. 2021;108(9): e289-e290.