title: Assessing surgeon stress when operating using heart rate variability and the State Trait Anxiety Inventory: will surgery be the death of us?
abstract: OBJECTIVE
  Performance in the operating room is affected by a combination of individual, patient and environmental factors amongst others. Stress has a potential negative impact on performance with the quality of surgical practice and patient safety being affected as a result. In order to appreciate the level of stress encountered during surgical procedures both objective and subjective methods can be used. This study reports the use of a combined objective (physiological) and subjective (psychological) method for evaluating stress experienced by the operating surgeon.
  
  
  METHODS
  Six consultant colorectal surgeons were evaluated performing eighteen anterior resections. Heart rate was recorded using a wireless chest strap at eight pre-determined operative steps. Heart Rate Variability indices were calculated offline using computerized software. Surgeon reported stress was collected using the State Trait Anxiety Inventory, a validated clinical stress scale.
  
  
  RESULTS
  A significant increase in stress was demonstrated in all surgeons whilst operating as indicated by sympathetic tone (control: 4.02 ± 2.28 vs operative: 11.42 ± 4.63; P < 0.0001). Peaks in stress according to operative step were comparable across procedures and surgeons. There was a significant positive correlation with subjective reporting of stress across procedures (r = 0.766; P = 0.0005).
  
  
  CONCLUSIONS
  This study demonstrates a significant increase in sympathetic tone in consultant surgeons measured using heart rate variability during elective colorectal resections. A significant correlation can be demonstrated between HRV measurements and perceived stress using the State Trait Anxiety Inventory. A combined approach to assessing operative stress is required to evaluate any effect on performance and outcomes.
authors.affiliation: Oxford University Hospitals, Oxford, UK.
authors.forename: K I
authors.initials: KI
authors.lastname: Jones
authors.forename: F
authors.initials: F
authors.lastname: Amawi
authors.forename: A
authors.initials: A
authors.lastname: Bhalla
authors.forename: O
authors.initials: O
authors.lastname: Peacock
authors.forename: J P
authors.initials: JP
authors.lastname: Williams
authors.forename: J N
authors.initials: JN
authors.lastname: Lund
mesh_terms: D001007:Anxiety / Q000503:physiopathology* / Q000523:psychology; D002277:Carcinoma / Q000601:surgery; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000601:surgery; D017558:Elective Surgical Procedures; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D013315:Stress, Psychological / Q000503:physiopathology* / Q000523:psychology; D066231:Surgeons / Q000523:psychology*
keywords: Stress; heart rate variability; objective; subjective; surgery