Increased surgeon stress may improve surgeon performance, surgical outcomes
Key takeaways:
- Increased surgeon physiological stress at the beginning of surgery was associated with reduced surgical complications.
- Optimizing the intraoperative stress levels of surgeons may improve surgical performance.
According to published results, increased surgeon stress in the first 5 minutes of surgery was associated with a significant decrease in major postoperative surgical complications.
“The results are illustrative of the complex relationship between physiological stress and performance,” Jake Awtry, MD, general surgery resident at Brigham and Women’s Hospital, and colleagues wrote in the study.
Awtry and colleagues performed a multicenter prospective cohort study of 38 attending surgeons and 793 patients (median age, 62 years) from 14 surgical departments across seven specialties.
According to the study, surgical specialties included orthopedic (28.9%), digestive, (18.7%), gynecologic (16%), urologic (11.3%), endocrine (11.2%), cardiac (10.6%) and thoracic (3.3%).
All surgeons were equipped with chest monitors to measure intraoperative heart rate. Awtry and colleagues then used heart rate values to derive a ratio of high- to low-frequency (LF:HF) sympathovagal balance to quantify surgeon stress levels.
Overall, median surgeon heart rate was 88 beats per minute. Median surgeon LF:HF ratio was 7.16 before normalization to the median value and 1 after normalization. Awtry and colleagues noted 114 patients (18.2%) had at least one major surgical complication and 30 patients (3.8%) had an extended ICU stay. Overall patient mortality rate was 1.8% (14 patients).
After controlling for patient, surgeon and surgical variables, Awtry and colleagues found increased surgeon LF:HF ratio during the first 5 minutes of surgery was associated with a significant reduction in major surgical complications (adjusted OR = 0.63; 95% CI, 0.41-0.98). However, they found increased surgeon stress was not associated with reduced ICU stays (aOR = 0.34; 95% CI, 0.11-1.01) or reduced mortality (aOR = 0.18; 95% CI, 0.03-1.03).
“These results suggest that optimizing surgeon stress may offer an avenue to improve surgical performance, with increased stress benefitting patient outcomes for experienced surgeons,” Awtry and colleagues concluded.
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