A PROSPECTIVE AUDIT EVALUATING THE SURGEON’S ‘TASK-LOAD’ PERFORMING SURGERY AROUND THE KNEE WITH AND WITHOUT A TOURNIQUET

Although tourniquets have traditionally been used in knee surgeries to improve intraoperative visibility, emerging evidence suggests their use in total knee replacements may increase the risk of adverse events. No studies have examined how tourniquet use affects the perceived workload of surgeons performing these procedures. This study investigated surgeon-perceived task load during knee surgeries with and without a tourniquet. Data were collected on total and partial knee replacements, high tibial osteotomies, and trauma-related operations. After each procedure, the lead surgeon completed the Surgical Task-Load Index (SURG-TLX) questionnaire, rating their workload across multiple domains. A weighted SURG-TLX score (0–100) was calculated. Surgical field visibility was rated on a 1–5 Likert scale. Of the total of 100 procedures, 47 were performed with a tourniquet and 53 without. Mean SURG-TLX scores were 39.65 (SD 18.98) for the tourniquet group and 41.59 (SD 19.26) for the no-tourniquet group. This difference was not clinically nor statistically significant (mean difference 2.04, p = 0.299). Field visibility was rated significantly higher in the tourniquet group (mean difference = 0.527, p = 0.001). Subgroup analyses showed no significant differences in individual SURG-TLX domains or between procedure types. Despite the reduction in field visibility, surgeons did not report increased workload demands when operating without a tourniquet. These findings, in combination with growing evidence of better short-term patient outcomes in tourniquet-free knee surgery, support wider adoption of tourniquet-free techniques as a more patient-centred surgical approach.