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When Surgeons Wear Stress Monitors During Procedures…

by Elizabeth Hofheinz, M.P.H., M.Ed.

In South Korea, it’s not always the patients who have all the monitors on during surgery. Several enterprising researchers undertook a pilot study to determine what would happen when spine surgeons wore monitors to assess their interoperative stress levels.

Their study, “Intraoperative real-time stress in degenerative lumbar spine surgery: simultaneous analysis of electroencephalography signals and heart rate variability,” appears in the August 2020 edition of The Spine Journal.

Byung Ho Lee is Clinical Professor of Orthopedic Spine Surgery at Severance Hospital, College of Medicine, Yonsei University. He commented to OSN, “Intraoperative stresses are affecting the surgeons, scrub nurses and finally the surgical outcome of the patients. Sometimes, the assistant doctors, usually clinical fellows, are missing some critical moment of surgery and the result would be a burden of the operator only.”

From junior to senior surgeons

The researchers included five orthopedic spine surgeons with clinical experience ranging from 1 to 30 years. They set out to look at stress levels among the spine surgeons and differences in stress parameters between novice and expert surgeons and between assistants and operators. A total of 179 recordings of intraoperative stress measures, including intraoperative electroencephalography signals and heart rate variability, comprising beats per minute (BPM) and low frequency/high frequency ratio, were collected and analyzed.

Asked if any prior work has been done in this area, he added, “There has been only limited work in different subspecialties such as cardiovascular surgery and oral and maxillofacial surgery. These studies only utilized the HRV [heart rate variability] or cortisol in saliva. However, with technical advances, we can utilize the real-time EEG and HRV at the same time.”

More tension, more bleeding?

“Among all measures, sensory-motor rhythm (SMR) waves, gamma waves, and BPM differed significantly during surgery,” said the authors. “Surgery duration and intraoperative bleeding were positively correlated with stress parameters, including gamma waves and tension. For operators, surgeon experience was negatively correlated with concentration, tension, and SMR, gamma, M-beta, and H-beta waves. However, for assistants, surgeon experience was positively correlated with concentration, tension, BPM, and SMR, M-beta, H-beta, and gamma waves. Bleeding amounts were correlated positively with gamma waves and tension for both operators and assistants. Stress among operators was higher than that among assistants in terms of low frequency/high frequency ratio.”

Dr. Lee told OSN, “The surgeon condition and the stresses changed during the surgery as expected. The less experienced, the more mental stresses for young surgeons. The longer duration of surgeries, the more physical stresses for senior surgeons. Especially, for the assistant doctors, their stresses and concentration are not always following that of the operator.”

“If concentration wanes during surgery, in critical moments, it would be helpful for surgeons and the surgical team to call attention of all members. Orthopedic spine surgeons should be aware of the pattern of stresses and team stress dynamics. That would facilitate a more fluent progression of surgical procedures with less stress.”

Elizabeth Hofheinz

Two time winner of the MORE award Ms. Hofheinz was the first writer employed by Orthopedics This Week. The MORE award is granted annually by the American Academy of Orthopaedic Surgeons to recognize excellence in journalism. Ms. Hofheinz is currently the Director of Communications for Ortho Spine Partners (OSP).

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