ArticleBJS open2024
Heart rate variability as a dynamic marker of surgeons' stress during vascular surgery.
Article in BJS open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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Who cites it
6 citing papers in PubMed.
- From incision to implantation: holter-based stress profiling in ophthalmology residents during cataract surgery.Graefe's archive for clinical and experimental ophthalmology = Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie · 2026Article
- Evaluating surgeons' stress using heart rate variability during minimally invasive surgery for gastric cancer: a single-center prospective cohort study.Langenbeck's archives of surgery · 2026Article
- Towards measuring the challenge: a narrative review on existing concepts and parallels for surgical struggle.Surgical endoscopy · 2026Review
- Clinicians' Stress Levels During Soft Tissue Augmentation Using Autogenous Connective Tissue Grafts: A Pilot Study.Clinical implant dentistry and related research · 2026Article
- Surgeons' physiological parameters and surgical performance: a systematic scoping review.Patient safety in surgery · 2025Review
- Daily physical activity habits influence surgeons' stress in the operating room: a prospective cohort study.International journal of surgery (London, England) · 2025Article
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Authors and funding
6 authors.
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Abstract
backgroundA 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.
methodsA 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.
resultsData 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.
conclusionHeart 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.
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