Heart rate variability as a measure of mental stress in surgery:A systematic review

PURPOSE: There is increasing interest in the use of heart rate variability (HRV) as an objective measurement of mental stress in the surgical setting. To identify areas of improvement, the aim of our study was to review current use of HRV measurements in the surgical setting, evaluate the different methods used for the analysis of HRV, and to assess whether HRV is being measured correctly. METHODS: A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA). 17 studies regarding HRV as a measurement of mental stress in the surgical setting were included and analysed. RESULTS: 24% of the studies performed long-term measurements (24 h and longer) to assess the long-term effects of and recovery from mental stress. In 24% of the studies, artefact correction took place. CONCLUSIONS: HRV showed to be a good objective assessment method of stress induced in the workplace environment: it was able to pinpoint stressors during operations, determine which operating techniques induced most stress for surgeons, and indicate differences in stress levels between performing and assisting surgery. For future research, this review recommends using singular guidelines to standardize research, and performing artefact correction. This will improve further evaluation of the long-term effects of mental stress and its recovery

Role of medical regulators in physician wellness:leading or lagging? A brief report on physician wellness practices

Background Physician wellness remains a growing concern, not only affecting the physicians’ quality of life but also the quality of care delivered. One of the core tasks of medical regulatory authorities (MRAs) is to supervise the quality and safety of care. This brief report aimed to evaluate the practices of MRAs regarding physician wellness and their views on residents as a high-risk group for decreased physician wellness. Methods A questionnaire was sent to MRAs worldwide, related to four topics: the identification of physician wellness as a risk factor for quality of care, data collection, interventions and the identification of residents as high risk for poor physician wellness. 26 responses were included. Results 23 MRAs consider poor physician wellness a risk factor for quality of care, 10 collect data and 13 have instruments to improve physician wellness. Nine MRAs identify residents as a high-risk group for poor physician wellness. Seven MRAs feel no responsibility for physician wellness. Conclusion Although almost all MRAs see poor physician wellness as a risk factor, actively countering this risk does not yet appear to be common practice. Given their unique position within the healthcare regulatory framework, MRAs could help improve physician wellness.</p

The Effects of Mental Fatigue on Surgical Performance:A Systematic Review

Introduction: The effect of mental fatigue and sleep deprivation on surgeons has been questioned for decades. While other high-stake professions such as aviation and military have already established guidelines to restrict work hours, this trend has yet to reach the surgical profession. This study aimed to give a complete and up-to-date overview of the existing literature regarding the impact of mental fatigue on surgical performance, in order to facilitate further research and the development of guidelines. Methods: A systematic review was performed searching Medline and Embase. 31 studies regarding the relation between fatigue and surgical performance, using both real-life surgery and simulator studies, were included. Articles based on patients as well as on surgeons and surgical residents were included. Articles based on stress, muscle fatigue, learning, work hour restrictions or regulations were excluded from analysis, as were studies on medical students and non-surgical professions. The methodological quality of the included studies was assessed using the Newcastle-Ottawa Scale. The studies were analyzed using descriptive statistics. Results: None of the studies on real-life surgery found a correlation between fatigue and surgical performance, but 45% of simulator studies found a negative correlation between fatigue and surgical performance, and 22% of simulator studies found a positive correlation. 8% of surgeon-based studies found a negative correlation, while 44,5% of intern-based studies did. Conclusion: In simulator studies, the effects of fatigue were mixed, but in real-life surgery, fatigue appears not to affect surgical performance. An explanation for this difference between simulator and real-life studies may lie in the fact that in real-life operations the stakes are higher and surgeons put in more effort to protect their performance against the detrimental effects of fatigue. However, surgical performance measures in real life operations were found to be rather crude, so it is unclear whether these measures were sufficiently sensitive to detect effects of fatigue if they do exist. We argue for more fine-grained performance measures in future research. Disclosure: Nothing to disclos

Impact of fatigue in surgeons on performance and patient outcome: systematic review

Background: While fatigue is an inevitable aspect of performing surgical procedures, lack of consensus remains on its effect on surgical performance. The aim of this systematic review was to assess the effect of non-muscular fatigue on surgical outcome. Methods: MEDLINE and Embase were searched up to 17 January 2023. Studies on students, learning, duty-hour restrictions, muscle fatigue, non-surgical or subjective outcome, the weekend effect, or time of admission were excluded. Studies were categorized based on real-life or simulated surgery. The Cochrane risk-of-bias tool was used to assess RCTs and the Newcastle-Ottawa scale was used to assess cohort studies. Due to heterogeneity among studies, data pooling was not feasible and study findings were synthesized narratively. Results: From the 7251 studies identified, 134 studies (including 1 684 073 cases) were selected for analysis (110 real-life studies and 24 simulator studies). Of the simulator studies, 46% (11 studies) reported a deterioration in surgical outcome when fatigue was present, using direct measures of fatigue. In contrast, only 35.5% (39 studies) of real-life studies showed a deterioration, observed in only 12.5% of all outcome measures, specifically involving aggregated surgical outcomes. Conclusion: Almost half of simulator studies, along with one-third of real-life studies, consistently report negative effects of fatigue, highlighting a significant concern. The discrepancy between simulator/real-life studies may be explained by heightened motivation and effort investment in real-life studies. Currently, published fatigue and outcome measures, especially in real-life studies, are insufficient to fully define the impact of fatigue on surgical outcomes due to the absence of direct fatigue measures and crude, post-hoc outcome measures

Impact of fatigue in surgeons on performance and patient outcome:systematic review

BACKGROUND: While fatigue is an inevitable aspect of performing surgical procedures, lack of consensus remains on its effect on surgical performance. The aim of this systematic review was to assess the effect of non-muscular fatigue on surgical outcome.METHODS: MEDLINE and Embase were searched up to 17 January 2023. Studies on students, learning, duty-hour restrictions, muscle fatigue, non-surgical or subjective outcome, the weekend effect, or time of admission were excluded. Studies were categorized based on real-life or simulated surgery. The Cochrane risk-of-bias tool was used to assess RCTs and the Newcastle-Ottawa scale was used to assess cohort studies. Due to heterogeneity among studies, data pooling was not feasible and study findings were synthesized narratively.RESULTS: From the 7251 studies identified, 134 studies (including 1 684 073 cases) were selected for analysis (110 real-life studies and 24 simulator studies). Of the simulator studies, 46% (11 studies) reported a deterioration in surgical outcome when fatigue was present, using direct measures of fatigue. In contrast, only 35.5% (39 studies) of real-life studies showed a deterioration, observed in only 12.5% of all outcome measures, specifically involving aggregated surgical outcomes.CONCLUSION: Almost half of simulator studies, along with one-third of real-life studies, consistently report negative effects of fatigue, highlighting a significant concern. The discrepancy between simulator/real-life studies may be explained by heightened motivation and effort investment in real-life studies. Currently, published fatigue and outcome measures, especially in real-life studies, are insufficient to fully define the impact of fatigue on surgical outcomes due to the absence of direct fatigue measures and crude, post-hoc outcome measures.</p

Performance variability in perioperative sentinel events: report on a nationwide data set

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