A Familiar Working Environment Influences Surgeon's Stress in the Operating Room: A Multi-Specialty Prospective Cohort Study.

Abstract

To determine the influence of operating room familiarity on surgeon stress. Regulating surgeon stress may improve patient safety. This study evaluated how assisting surgeons and operating room familiarity influence intraoperative heart rate variability among surgeons. Attending surgeons from 7 specialties within 4 university hospitals in France were enrolled from November 1, 2020 to December 31, 2021. Vagal tone, an indicator of stress derived from heart rate variability, was assessed during the first 5 minutes after incision using the root mean square of successive differences (RMSSD). Higher RMSSD values indicate greater vagal tone. Team familiarity was quantified as the cumulative time the attending and assisting surgeons had operated together in the past, while operating rooms in which the surgeon conducted >10% of their operations were termed familiar. The effect of each on the RMSSD was assessed via a linear mixed-effect model adjusting for the random effect of the surgeon and possible confounders. Overall, 643 surgeries performed by 37 surgeons were included. The median surgeon age was 49 years; 299 (78.4%) were male, and 22 (59.5%) were professors. Surgeons spent an average of 21.2 hours with the assisting surgeon before surgery and conducted 585 (91.0%) of their operations in a familiar operating room. For every 10 additional hours spent operating together, ln(RMSSD) significantly increased by 0.018 (95% CI: 0.003 to 0.033, P =0.016). Familiar operating rooms also tended to increase surgeon ln(RMSSD) [0.098 (95%CI: -0.007 to 0.203, P =0.068)]. Familiar with assisting surgeons and potentially operating rooms, increased surgeon vagal tone. Maintaining a stable operating room environment may improve surgeon stress and patient care.