Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2018 Sep 27;3(1):119-125.
doi: 10.1002/bjs5.104. eCollection 2019 Feb.

Acute mental stress and surgical performance

P D Grantcharov  1 , T Boillat  1   2 , S Elkabany  3 , K Wac  1   4   5 , H Rivas  1
Affiliations
Observational Study

Acute mental stress and surgical performance

P D Grantcharov et al. BJS Open. .

Abstract

Background: Stress 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.

Methods: Continuous 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.

Results: Rates 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).

Conclusion: There 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.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Surgical event rates during different stress levels: a 1‐min interval, b 2‐min interval, c 5‐min interval. SDNN, standard deviation of RR intervals; RMSSD, root mean square of successive differences in RR intervals
See this image and copyright information in PMC

References

    1. Sexton JB, Thomas EJ, Helmreich RL. Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ 2000; 320: 745–749. - PMC - PubMed
    1. Hammermeister J, Burton D. Stress, appraisal, and coping revisited: examining the antecedents of competitive state anxiety with endurance athletes. Sport Psychol 2001; 15: 66–90.
    1. Campbell DA Jr, Sonnad SS, Eckhauser FE, Campbell KK, Greenfield LJ. Burnout among American surgeons. Surgery 2001; 130: 696–705. - PubMed
    1. Tomaka J, Blascovich J, Kelsey RM, Leitten CL. Subjective, physiological, and behavioral effects of threat and challenge appraisal. J Pers Soc Psychol 1993; 65: 248–260.
    1. LeBlanc VR. The effects of acute stress on performance: implications for health professions education. Acad Med 2009; 84(Suppl): S25–S33. - PubMed

Publication types