Abstract
Can we recognize intraoperative real-time stress of orthopedic surgeons and which factors affect the stress of intraoperative orthopedic surgeons with EEG and HRV? From June 2018 to November 2018, 265 consecutive records of intraoperative stress measures for orthopedic surgeons were compared. Intraoperative EEG waves and HRV, comprising beats per minute (BPM) and low frequency (LF)/high frequency (HF) ratio were gathered for stress-associated parameters. Differences in stress parameters according to the experience of surgeons, intraoperative blood loss, and operation time depending on whether or not a tourniquet were investigated. Stress-associated EEG signals including beta 3 waves were significantly higher compared to EEG at rest for novice surgeons as the procedure progressed. Among senior surgeons, the LF/HF ratio reflecting the physical demands of stress was higher than that of novice surgeons at all stages. In surgeries including tourniquets, operation time was positively correlated with stress parameters including beta 1, beta 2, beta 3 waves and BPM. In non-tourniquet orthopedic surgeries, intraoperative blood loss was positively correlated with beta 1, beta 2, and beta 3 waves. Among orthopedic surgeons, those with less experience demonstrated relatively higher levels of stress during surgery. Prolonged operation time or excessive intraoperative blood loss appear to be contributing factors that increase stress.
Highlights
The stress of workers in the medical field is undeniable and is an essential factor in healthcare quality management, given that despite the best of intentions and efforts patients’ health is not guaranteed
This study aims to evaluate the real-time intraoperative stress analysis using wearable 2-channel EEG and heart rate variability detecting devices worn by orthopedic surgeons while performing surgery
Intraoperative stress using wearable EEG and heart rate variability (HRV) detecting device was measured in 265 cases, and eight orthopedic surgeons were enrolled
Summary
The stress of workers in the medical field is undeniable and is an essential factor in healthcare quality management, given that despite the best of intentions and efforts patients’ health is not guaranteed. Surgery is a stressful profession as it can affect the patient’s life and function given constant long working hours, highly intensive procedures, large learning curve required for conducting more than a certain degree [1,2,3]. Perhaps the stress will increase more than the resting state of meditating peacefully, but we will not be able to know in real time the information on the extent and pattern of the increase. While various methods have been used to evaluate stress among surgeons, including questionnaires, heart rate, sympathovagal balance, heart rate variability (HRV), thermal activity, stress biomarkers in saliva, and smart patches [5,6,7,8,9,10], such methods do not accurately reflect the degree and type of stress in real-time and have limitations that are difficult to validate to the general public
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