ReviewCureus2026
Decision Fatigue in the Attending Surgeon: The Neural Accumulation of Micro-decisions Across an Operating Day.
Review in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Decision fatigue represents a progressive deterioration in decision-making quality arising from the cumulative cognitive burden of repeated choices. Attending surgeons navigate hundreds of micro-decisions throughout an operating day, encompassing instrument selection, tissue handling, and real-time adjustments in surgical approach, particularly when unexpected intraoperative findings demand immediate adaptive reasoning, each drawing upon finite neural resources. This review synthesizes current evidence on the neural mechanisms underlying decision fatigue in surgeons, with particular emphasis on prefrontal cortex (PFC) depletion, neurotransmitter dynamics, and metabolic constraints. We propose a taxonomy of intraoperative micro-decisions organized by strategic versus tactical, perceptual versus conceptual, time-critical versus deliberative, and reversible versus irreversible dimensions. Evidence demonstrates that decision fatigue manifests in measurable performance decrements, including prolonged operative times, increased error rates, and elevated complication risks, particularly in later cases of the operating day when unexpected intraoperative findings compound the risk posed by accumulated cognitive depletion. Individual factors such as experience, stress resilience, and sleep quality, together with systemic variables including case scheduling, team dynamics, and technology support, moderate these effects. Mitigation strategies encompass individual-level interventions (strategic breaks, nutrition optimization, cognitive training), team-based approaches including a second attending surgeon as cognitive monitor, technological cognitive offloading, and system-level organizational change. Critical research gaps include the need for real-time intraoperative neural monitoring, validated micro-decision taxonomies, and prospective trials of mitigation protocols. Understanding decision fatigue as a neurobiological phenomenon rather than a character flaw is essential for developing evidence-based strategies that optimize surgeon performance and patient safety.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.