A recent study published in JAMA Surgery reveals a surprising connection between surgeon stress at the start of a procedure and patient outcomes. According to the study, higher levels of physiological stress in surgeons during the first five minutes of surgery were associated with fewer major complications for patients.
The study, led by Dr. Jake Awtry from Brigham and Women’s Hospital in Boston, involved 793 surgical procedures across 14 departments in four university hospitals.
A total of 38 attending surgeons participated in this multicenter study, which aimed to explore how surgeon stress, measured through physiological markers, might impact surgical outcomes.
Measuring Surgeon Stress
The researchers assessed surgeon stress using a metric called sympathovagal balance, which reflects the interplay between the sympathetic (“fight or flight”) and parasympathetic (“rest and digest”) nervous systems.
This balance was evaluated through heart rate and heart rate variability measurements. The median heart rate among surgeons during the procedures was 88 beats per minute, with a median low-frequency to high-frequency ratio of 7.16, indicating a heightened stress response.
Key Findings
The analysis uncovered an intriguing association between increased surgeon stress early in the operation and better patient outcomes. Specifically:
- Reduced Major Surgical Complications: Surgeons with higher sympathovagal balance during the first five minutes of surgery were less likely to have patients with major postoperative complications. The adjusted odds ratio was 0.63, meaning the likelihood of complications was reduced by 37% compared to cases where the surgeon exhibited lower stress levels (P = 0.04).
- Other Outcomes: The study found no significant association between early surgeon stress and reduced intensive care unit (ICU) stays (P = 0.05) or mortality (P = 0.05), although trends suggested potential connections worth further exploration.
Understanding the Results
The findings highlight a complex relationship between stress and performance. Higher stress levels at the beginning of surgery might enhance focus and vigilance, leading to better decision-making and execution during critical phases of the procedure.
This aligns with research in other high-stakes fields, such as aviation and athletics, where moderate stress can enhance performance.
However, it is essential to note that excessive or prolonged stress could have detrimental effects, potentially leading to fatigue or burnout over time.
The study emphasizes the need to strike a balance, where the stress response is enough to heighten awareness and precision without causing negative long-term consequences for surgeons.
Implications for Surgical Practice
The study underscores the importance of addressing human factors in surgery, particularly how physiological and psychological states affect outcomes. Recognizing the link between surgeon stress and performance may lead to practical changes, such as:
- Training and Preparation: Programs could incorporate stress management techniques or simulations to optimize surgeons’ focus and readiness at the start of procedures.
- Monitoring Systems: Real-time tools to assess and manage physiological stress during surgery could help surgeons maintain an optimal performance state.
- Research Expansion: Further studies are needed to explore the mechanisms behind the observed effects and whether interventions could enhance these benefits without adding unnecessary strain on surgeons.
Conclusion
This research provides valuable insights into how the early stress response of surgeons impacts patient outcomes.
While the association between initial stress and reduced complications is promising, it also highlights the need to better understand and manage surgeon stress to ensure both patient safety and the well-being of surgical teams.
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The study is published in JAMA Surgery.
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