Section of Bariatric and Minimally Invasive Surgery, Department of Surgery Stanford University School of Medicine Stanford California USA.
Department of Computer Science Lucerne University of Applied Sciences and Arts Lucerne Switzerland.
BJS Open. 2018 Sep 27;3(1):119-125. doi: 10.1002/bjs5.104. eCollection 2019 Feb.
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.
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.
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 ( < 0·001).
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.
压力已被证明会对影响最佳表现的多个关键方面产生不利影响。可穿戴技术的进步可以减少在手术中观察压力的障碍。本研究旨在探讨急性术中精神压力与手术技术表现之间的关联。
在手术过程中连续记录一位主治外科医生的心电图数据，以获得心率变异性（HRV）测量值，作为急性精神压力的替代指标。使用了两种不同的测量方法：连续差异的均方根（RMSSD）和 RR 间隔标准差（SDNN）。使用通用错误评分工具（GERT）在手术室黑盒®平台上评估手术技术表现。HRV 记录和手术录像均进行了时间标记。将手术程序分割为不重叠的 1、2 和 5 分钟间隔，并进行数据分析。事件定义为任何导致患者受伤或造成伤害风险的偏差。
在使用两种急性精神压力替代指标测量的所有间隔长度中，高压力分位数的事件发生率明显更高（47-66%更高）。使用 RMSSD 作为 HRV 测量值时，1 分钟间隔观察到的关联最强（<0.001）。
急性精神压力测量值与较差的手术技术表现之间存在关联。进一步的研究将有助于描绘这些变量的相互依存关系，并确定压力水平升高的触发因素，以提高手术安全性。
