Department of Vascular Surgery, Division of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.
BJS Open. 2024 Sep 3;8(5). doi: 10.1093/bjsopen/zrae097.
A surgeon experiences elevated stress levels when operating. Acute stress is linked to cognitive overload, worsening surgical performance. Chronic stress poses a significant risk to a surgeon's health. Identifying intraoperative stress may allow for preventative strategies that reduce surgeons' stress and subsequently improve patient outcomes. The aim of this study was to assess the feasibility of using heart rate variability as a marker of stress during vascular surgery.
A total of 11 senior surgeons were evaluated performing three different vascular surgery procedures. Heart rate variability metrics (low-frequency to high-frequency ratio and standard deviation of the normal-normal interval) were determined from single-lead ECG traces at predetermined procedural performance points. State-Trait Anxiety Inventory-6, a validated stress tool, was used to assess surgeon-reported stress. Subjective reports of procedural difficulty were also collected. One-way ANOVA compared heart rate variability at key performance points with baseline. Pearson's coefficient assessed correlation between heart rate variability and subjective stress.
Data were collected for six carotid endarterectomies, six open abdominal aortic aneurysm repairs, and five lower limb bypasses. Heart rate variability metrics indicating markedly greater stress were observed at key performance points across all procedures. Peaks in stress were consistent across different surgeons performing the same procedure. A significant correlation was observed between heart rate variability metrics and subjective State-Trait Anxiety Inventory-6 stress reports (r = 0.768, P =<0.001). The most difficult procedural steps reported corresponded with heart rate variability metrics displaying the greatest stress.
Heart rate variability may be a viable approach to assess intraoperative stress and cognitive load during vascular surgery and could be used to evaluate whether a theatre intervention (for example timeout) could reduce stress in areas of surgical difficulty.
外科医生在手术时会经历压力水平升高。急性应激与认知负荷增加有关，会导致手术表现恶化。慢性应激对外科医生的健康构成重大风险。识别手术中的应激可能允许采取预防策略，以减轻外科医生的压力，从而改善患者的预后。本研究的目的是评估使用心率变异性作为血管手术中应激标志物的可行性。
共评估了 11 名资深外科医生进行的三种不同的血管手术程序。在预定的程序性能点，从单导联心电图迹线上确定心率变异性指标（低频到高频比和正常-正常间隔的标准差）。使用状态-特质焦虑量表-6（一种经过验证的应激工具）评估外科医生报告的应激。还收集了程序难度的主观报告。单向方差分析比较了关键绩效点与基线的心率变异性。Pearson 相关系数评估了心率变异性与主观应激之间的相关性。
共收集了 6 例颈动脉内膜切除术、6 例开放式腹主动脉瘤修复术和 5 例下肢旁路术的数据。在所有程序的关键绩效点都观察到指示明显更大压力的心率变异性指标。不同外科医生执行相同的手术时，压力峰值是一致的。心率变异性指标与主观状态-特质焦虑量表-6 应激报告之间存在显著相关性（r = 0.768，P < 0.001）。报告的最困难的程序步骤与显示最大压力的心率变异性指标相对应。
心率变异性可能是评估血管手术期间术中应激和认知负荷的可行方法，并可用于评估剧院干预（例如超时）是否可以减轻手术困难区域的应激。
