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eComment: Stress levels of the surgeon within and beyond theoperating room

Hannover Medical School, Plastic, Hand and Reconstructive Surgery, Hannover, Germany

Intraoperative heart rate variability of a cardiac surgeon himself in coronary artery bypass grafting surgery

I read with great interest the report by Dr. Song and co-workers evaluating the heart rate variability as a measure of stress levels of a cardiac surgeon [1]. Notably, the stress levels differ from performing a coronary artery bypass grafting (CABG) procedure on their own or assisting it to residents. Interestingly, the resident-trainee surgeons refused to have their intraoperative electrocardiogram recorded, which would have been of distinct interest in my personal view. It seems that the more experienced a surgeon, the greater is the expected decline in stress levels throughout a standardized procedure at daytime. However, the impact of on-call procedures during after-office hours might be determined in the future.

Stress levels of a given surgeon should be regarded in a larger perspective beyond the OR. Pressure due to time constraints, administrative pressure and/or personal attitudes towards stress management are likely to influence the response of a given surgeon to stress. It would be interesting to know whether stress levels in the OR are similar as following administrative tasks outside the OR?

In surgical training in general surgery, intraoperative cardiac rate increased by 4–10%, particularly in the resident serving as primary surgeon during laparoscopic cholecystectomy [2]. The most stressful moments of the aforementioned general surgical procedure were the draping of the surgical field, trocar placement, clip application, and extraction of the gallbladder. Perceived stress levels among surgeons during a 24-hour-shift correlate with heart rate variability, whereas fatigue does not [3]. Stress-coping strategies may play a role in this regard, too [4].

Thus, the stress of the surgeon within and beyond the OR is of distinct interest.

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1. Song MH, Tokuda Y, Nakayama T, Sato M, Hattori K. Intraoperative heart rate variability of a cardiac surgeon himself in coronary artery bypass grafting surgery. Interact CardioVasc Thorac Surg 2009;8:639–641.[Abstract/Free Full Text]
2. Mongin C, Dufour F, Lattanzio F, Champault G. Evaluation of stress in surgical trainees: prospective study of heart rate during laparoscopic cholecystectomy. J Chir (Paris) 2008;145:138–142.[Medline]
3. Langelotz C, Scharfenberg M, Haase O, Schwenk W. Stress and heart rate variability in surgeons during a 24-hour shift. Arch Surg 2008;143:751–755.[Abstract/Free Full Text]
4. Hassan I, Osei-Agymang T, Radu D, Gerdes B, Rothmund M, Fernandez ED. Simulation of laparoscopic surgery – four years' experience at the Department of Surgery of the University Hospital Marburg. Wien Klin Wochenschr 2008;120:70–76.[CrossRef][Medline]

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