Heart rate variability as a measure of mental stress in surgery: a systematic review

Abstract

Purpose There is increasing interest in the use of heart rate variability (HRV) as an objective measurement of mental stress in the surgical setting. To identify areas of improvement, the aim of our study was to review current use of HRV measurements in the surgical setting, evaluate the different methods used for the analysis of HRV, and to assess whether HRV is being measured correctly. Methods A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). 17 studies regarding HRV as a measurement of mental stress in the surgical setting were included and analysed. Results 24% of the studies performed long-term measurements (24 h and longer) to assess the long-term effects of and recovery from mental stress. In 24% of the studies, artefact correction took place. Conclusions HRV showed to be a good objective assessment method of stress induced in the workplace environment: it was able to pinpoint stressors during operations, determine which operating techniques induced most stress for surgeons, and indicate differences in stress levels between performing and assisting surgery. For future research, this review recommends using singular guidelines to standardize research, and performing artefact correction. This will improve further evaluation of the long-term effects of mental stress and its recovery.

The effect of preferred music on mental workload and laparoscopic surgical performance in a simulated setting (OPTIMISE): a randomized controlled crossover study

“…Although reporting bias cannot be entirely ruled out, the SURG-TLX follows the trend of objective parameters like salivary cortisol levels [43]. HRV seems to be an adequate method to assess mental surgical stress as well [44]. While heart rate was statistically significantly higher (within subject difference 1.0 bpm, p = 0.046) and HRV lower (within subject difference − 2.5, p = 0.015) in the music group, the absolute difference observed cannot be considered clinically relevant.…”

“…Music did significantly reduce mental workload and several previously identified key stressors of surgery, and its use in the operating theater is reportedly viewed favorably. Higher perceived stress is associated with a decreased HRV even throughout the night, indicative of a protracted recovery time [44]. As music can attenuate the stress response to surgery in patients undergoing surgery, future research should incorporate its effect on mental workload through HRV with attention to recovery from surgical task performance as well.…”

Heart rate variability as a strain indicator for psychological stress for emergency physicians during work and alert intervention: a systematic review

“…HRV is also used to study stress levels of surgeons during operations. The review by The et al shows that there are significantly more studies on this topic ( n = 17) [ 17 ]. For example, reviews showed that stressed surgeons (e.g., intraoperatively) offered reduced HRV [ 16 , 17 ].…”

“…The analysis of heart rate variability (HRV) is a possible method for objective monitoring of workload [ 15 ]. HRV is often used for stress identification in surgeons [ 16 , 17 ]. The HRV is defined as variations in time between consecutive heart beats and it’s a very sensitive indicator for dysregulation of the autonomic nervous system (ANS) [ 18 , 19 ].…”

Wearable Devices Suitable for Monitoring Twenty Four Hour Heart Rate Variability in Military Populations

“…Heart rate variability (HRV) is a measure of the variation in time between adjacent heartbeats, otherwise known as R-R intervals [ 1 , 2 ]. HRV is a powerful biomarker and is sensitive to the level of activity and work, of both physiological and psychological systems [ 3 ].…”