Peak Intraoperative Physiologic Stress Correlates With Stress Perception Among Surgeons In The Surgeon Athlete Connection

PURPOSE: Operating is an inherently stressful endeavor. Studies show that an individual’s experience and interpretation of stress have a strong influence on both their short- and long-term health. This study aimed to evaluate the relationship between physiologic stress and stress perception among resident and faculty surgeons during operations. METHODS: Resident and faculty surgeons who complete at least one case longer than 3 hours per week from a large midwestern academic medical center were enrolled in the 14-day study. Participants were outfitted with an electrical heart rate sensor which recorded a variety of heart rate metrics while operating. Participants also completed the SurgTLX survey immediately after each case. Post-hoc analysis converted the raw data into a sympathetic nervous system (SNS) activation index and a stress index. Since the dataset was not normally distributed, Spearman’s correlation was conducted and P < 0.05 was used as the threshold for significance. RESULTS: Data from 19 surgeons (63% male) encompassing 2 fellows, 8 residents, and 9 faculty from 8 different specialties were included in this analysis. In total, 67 cases were analyzed with an average case duration of 4 hours 9 minutes. The SurgTLX intraoperative stress question was significantly and positively correlated with the maximum stress index (ρ = 0.305, P = 0.037) but not the average stress (ρ = 0.183, P = 0.217) or the minimum stress (ρ = -0.044, P = 0.767) recorded during the cases. When looking at SNS activation, a similar pattern emerged as the maximum SNS activation was significantly and positively correlated with the intraoperative stress question (ρ = 0.293, P = 0.046) but average (ρ = 0.151, P = 0.312) and minimum (ρ = -0.077, P = 0.607) SNS activation were not. CONCLUSIONS: Surgeon perception of stress while operating appears to be impacted by moments of maximum physiologic stress and sympathetic nervous system activation encountered while operating rather than the average or minimum amounts of stress over the course of a case. Future work should explore interventions that could help surgeons better cope with the points of greatest stress while operating to enhance surgeon resilience and wellbeing.