Surgical Duration Is Associated With Subjective And Physiologic Performance Metrics In The Surgeon Athlete Connection

PURPOSE: Surgery is physically and mentally demanding; however, attention has only recently focused on understanding the relationship between surgeon intraoperative physiology and intraoperative performance. This study aimed to assess how surgical duration affects key surgeon biometrics and workload. 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 wore an electrical heart rate sensor while operating and completed the SurgTLX survey immediately after each case to assess workload. Sympathetic nervous system (SNS) activation and stress index were determined by post-hoc analysis. Since the data 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 analyzed. In total, 67 cases were included with an average duration of 4 hours 9 minutes (range = 42 m-13h17m). Accumulated SNS activation and stress were positively and significantly associated with case duration (ρ = 0.448, P = <0.001 and ρ = 0.610, P = <0.001, respectively). The SurgTLX composite score was positively associated with case duration. On an individual item level, mental demand (ρ = 0.463, P = <0.001), temporal demand/time pressure (ρ = 0.366, P = 0.007), and task complexity (ρ = 0.424, P = 0.002) were positively correlated with case duration. However, physical demand (ρ = 0.120, P = 0.393), situational stress/anxiety (ρ = 0.249, P = 0.084) and environmental distractions (ρ = 0.229, P = 0.099) were not significantly correlated with case duration. CONCLUSIONS: Longer surgical cases are associated with greater physiologic stress and increased task workload, which is primarily driven by mental demand, task complexity, and time pressure. Interestingly, perceived physical exertion does not increase with case duration, suggesting that cognitive load and perceived time constraints are major contributors to surgeon stress during extended operations. This research reveals the opportunity for targeted interventions to reduce mental fatigue during long operations to enhance surgeon wellbeing and performance.