Abstract
BackgroundDuring surgery, surgeons often work under stressful conditions, which could affect patient safety. Reducing intraoperative stress for surgeons could benefit surgeons and subsequently patients. It is difficult to study stress and stress relief in real life situations due to the multitude of confounding factors. The aim of this study was to evaluate simulated intraoperative stressors on surgeons’ stress levels and the effect of an intervention (pause including a sugar-containing drink) during standardized experiments (simulated operations).MethodsAn experimental interventional study was conducted using a simulator. The healthy surgeon volunteers were randomized to intervention and control in a cross-over design. Primary endpoint was salivary cortisol difference between a pause including a sugar containing drink (intervention) and controls. Secondary endpoints were change in heart rate, change in self-perceived stress measured by the State Trait Anxiety Inventory (STAI), and experience of the intraoperative pause. Endpoints were calculated with a mixed effect analysis of covariance (ANCOVA) model.ResultsSeventeen surgeons performed 32 experiments. There was no statistically significant difference in salivary cortisol between simulations with and without a pause including a sugar-containing drink; percent reduction, 8% (0.92 (95%CI:0.72;1.18)), p-value = 0.469. The surgeons’ self-estimation of intervention was positive, but there was no statistically significant difference in heart rate or STAI.ConclusionsThe surgeons’ experience of a pause including a drink was positive but there were no differences in physiological outcomes of the intervention. Lessons learned from this study could contribute to optimizing design of future studies.Trial registrationClinicaltrials.gov NCT04626648, Registered November 6, 2020, retrospectively registered.
Highlights
During surgery, surgeons often work under stressful conditions, which could affect patient safety
Studies have been conducted on different sorts of intraoperative pauses in various settings and the results indicate that intraoperative pauses reduce stress levels, surgical errors and physical discomfort without prolonging the operating time [11, 23,24,25]
Based on the hypothesis that intraoperative pauses every other hour including a sugar-containing drink would decrease surgeon’s stress levels, the aim of this study was to compare physiologic stress levels measured as cortisol and heart rate, in relation to intraoperative stress and how they was affected by a pause including a sugarcontaining drink during simulated operations
Summary
Surgeons often work under stressful conditions, which could affect patient safety. The aim of this study was to evaluate simulated intraoperative stressors on surgeons’ stress levels and the effect of an intervention (pause including a sugar-containing drink) during standardized experiments (simulated operations). Stress among professionals in the OR has been linked to decreased patient safety as it has been described to affect surgical performance and intraoperative teamwork negatively [1,2,3,4,5,6]. Knowledge of factors that influence the level of intraoperative stress among members of the operating team are important. Surgeons may regularly be exposed to various stressors during surgery such as poor teamwork, distractions/interruptions, patient factors, time pressure/management, technical problems, equipment problems, and personal factors [5, 9, 10]. Stress has sometimes been perceived as a sign of weakness and as something that does not affect “me”, but may affect other surgeons [5, 16]
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