Assessing surgeon stress when operating using heart rate variability and the State Trait Anxiety Inventory: will surgery be the death of us?

Jones, Keaton; Amawi, F; Bhalla, Ashish; Peacock, Oliver; Williams, John P.; Lund, Jonathan N.

doi:10.1111/codi.12844

Cited by 72 publications

(88 citation statements)

References 34 publications

(47 reference statements)

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“…Our findings are consistent with previous studies that have also demonstrated a significant variation in levels of stress using HRV between procedural steps in a clinical environment (Song et al 2009;Jones et al 2015). HRV has been previously been well correlated with STAI by our group in consultant surgeons performing elective colorectal resections (Jones et al 2015) and in consultant anaesthetists during intubation (Doleman et al 2016), but this study suggests that this may not be the case in the simulated environment.…”

Section: Discussionsupporting

confidence: 92%

“…Assessment of these fluctuations allows for the relative contribution of the sympathetic and parasympathetic nervous systems to be calculated (Jones et al 2015). Mental stress results in an increase in sympathetic output, which is reflected in HRV recordings (Akselrod et al 1985;Malliani et al 1991;Mølgaard 1991).…”

Section: Introductionmentioning

confidence: 99%

“…Mental stress results in an increase in sympathetic output, which is reflected in HRV recordings (Akselrod et al 1985;Malliani et al 1991;Mølgaard 1991). HRV has been used previously in multiple studies to demonstrate increases in intra-operative stress in surgeons (Böhm et al 2001;Song et al 2009;Jones et al 2015), and for the assessment of training effectiveness and simulator realism in simulated flight (Jorna 1993). HRV can be measured dynamically, non-invasively, and remotely, allowing stress to be measured objectively at defined time points with no interruption during the accomplishment of a given clinical or technical procedure.…”

Section: Introductionmentioning

confidence: 99%

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Simulation fails to replicate stress in trainees performing a technical procedure in the clinical environment

et al. 2016

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A note on versions:The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription. Abstract IntroductionSimulation based training (SBT) has become an increasingly important method by which doctors learn. Stress has an impact upon learning, performance, technical, and non-technical skills. However, there are currently no studies that compare stress in the clinical and simulated environment. We aimed to compare objective (heart rate variability, HRV) and subjective (state trait anxiety inventory, STAI) measures of stress theatre with a simulated environment. MethodsHRV recordings were obtained from eight anaesthetic trainees performing an uncomplicated rapid sequence induction at pre-determined procedural steps using a wireless Polar RS800CX monitor © in an emergency theatre setting. This was repeated in the simulated environment. Participants completed an STAI before and after the procedure. ResultsEight trainees completed the study. The theatre environment caused an increase in objective stress vs baseline (p=0.004). There was no significant difference between average objective stress levels across all time points (p=0.20) between environments.However, there was a significant interaction between the variables of objective stress 2 and environment (p=0.045). There was no significant difference in subjective stress (p=0.27) between environments. DiscussionSimulation was unable to accurately replicate the stress of the technical procedure. This is the first study that compares the stress during SBT with the theatre environment and has implications for the assessment of simulated environments for use in examinations, rating of technical and non-technical skills, and stress management training.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Simulation fails to replicate stress in trainees performing a technical procedure in the clinical environment

et al. 2016

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“…After reperfusion of the liver, the value of the HF was obviously increased, that is, the sympathetic nervous activity subsided and this may be compatible with subjective relief from mental strain. A previous study demonstrated a significant correlation between the HRV measurement and perceived stress, evaluated using the STAI, in various steps during colorectal surgery (Jones et al 2015). In our study, the changes in the HF or the LF/HF were not always consistent among the cases of LDLT, possibly due to various situations regarding the surgeon himself or assistants or patients' condition such as constitution or stage of disease progression, and possibly the environment regarding operation.…”

Section: Discussioncontrasting

confidence: 64%

“…Recently, there have been reports regarding HRV analyses during surgical operations (Song et al 2009;Prichard et al 2012). In low anterior resection of the rectum, experienced surgeons showed a significant increase in the sympathetic tone, which represented the increased stress, and moreover, significant correlation was demonstrated between the HRV measurements and perceived amount of stress (Jones et al 2015).…”

Section: Introductionmentioning

confidence: 99%

Increase in Operator’s Sympathetic Nerve Activity during Complicated Hepatobiliary Surgery: Evidence for Surgeons’ Mental Stress

Yamanouchi

Hayashida

Kuba

et al. 2015

Tohoku J. Exp. Med.

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Surgeons often experience stress during operations. The heart rate variability (HRV) is the variability in the beat-to-beat interval, which has been used as parameters of stress. The purpose of this study was to evaluate mental stress of surgeons before, during and after operations, especially during pancreaticoduodenectomy (PD) and living donor liver transplantation (LDLT). Additionally, the parameters were compared in various procedures during the operations. By frequency domain method using electrocardiograph, we measured the high frequency (HF) component, representing the parasympathetic activity, and the low frequency (LF)/HF ratio, representing the sympathetic activity. In all 5 cases of PD, the surgeon showed significantly lower HF component and higher LF/HF during operation, indicating predominance of sympathetic nervous system and increased stress, than those before the operation (p < 0.01) and these did not return to the baseline level one hour after the operation. Out of the 4 LDLT cases, the value of HF was decreased in two and the LF/HF increased in three cases (p < 0.01) during the operation compared to those before the operation. In all cases, the value of HF was decreased and/or the LF/HF increased significantly during the reconstruction of the vessels or bile ducts than during the removal of the liver. Thus, sympathetic nerve activity increased during hepatobiliary surgery compared with the level before the operation, and various procedures during the operations induced diverse changes in the autonomic nervous activities. The HRV analysis could assess the chronological changes of mental stress by measuring the autonomic nervous balances.

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Acute mental stress and surgical performance

et al. 2018

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BackgroundStress has been shown to impact adversely on multiple facets critical to optimal performance. Advancements in wearable technology can reduce barriers to observing stress during surgery. This study aimed to investigate the association between acute intraoperative mental stress and technical surgical performance.MethodsContinuous electrocardiogram data for a single attending surgeon were captured during surgical procedures to obtain heart rate variability (HRV) measures that were used as a proxy for acute mental stress. Two different measures were used: root mean square of successive differences (RMSSD) and standard deviation of RR intervals (SDNN). Technical surgical performance was assessed on the Operating Room Black Box® platform using the Generic Error Rating Tool (GERT). Both HRV recording and procedure video recording were time‐stamped. Surgical procedures were fragmented to non‐overlapping intervals of 1, 2 and 5 min, and subjected to data analysis. An event was defined as any deviation that caused injury to the patient or posed a risk of harm.ResultsRates of events were significantly higher (47–66 per cent higher) in the higher stress quantiles than in the lower stress quantiles for all measured interval lengths using both proxy measures for acute mental stress. The strongest association was observed using 1‐min intervals with RMSSD as the HRV measure (P < 0·001).ConclusionThere is an association between measures of acute mental stress and worse technical surgical performance. Further study will help delineate the interdependence of these variables and identify triggers for increased stress levels to improve surgical safety.

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Assessing surgeon stress when operating using heart rate variability and the State Trait Anxiety Inventory: will surgery be the death of us?

Cited by 72 publications

References 34 publications

Simulation fails to replicate stress in trainees performing a technical procedure in the clinical environment

Simulation fails to replicate stress in trainees performing a technical procedure in the clinical environment

Increase in Operator’s Sympathetic Nerve Activity during Complicated Hepatobiliary Surgery: Evidence for Surgeons’ Mental Stress

Acute mental stress and surgical performance

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