The perceived benefit of intraoperative stress modifiers for surgeons: an experimental simulation study in volunteers

Sofia Erestam, David Bock, Annette Erichsen Andersson, Eva Haglind, Jennifer Park, Eva Angenete, Sofia Erestam, David Bock, Annette Erichsen Andersson, Eva Haglind, Jennifer Park, Eva Angenete

Abstract

Background: During 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).

Methods: An 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.

Results: Seventeen 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.

Conclusions: The 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 registration: Clinicaltrials.gov NCT04626648 , Registered November 6, 2020, retrospectively registered.

Keywords: Patient safety; Saliva cortisol; Stress; Surgical simulation; Work break.

Conflict of interest statement

The authors have no competing interests.

Figures

Fig. 1
Fig. 1
The simulator set-up
Fig. 2
Fig. 2
Flow Chart. *Two surgeons did not participate in the second period due to practical reasons
Fig. 3
Fig. 3
Timeline for measurements. *Intervention = pause including a sugar-containing drink or control = no pause. ** Total time for simulations differed between 0:40 h to 2:02 h
Fig. 4
Fig. 4
Change in Cortisol, heart rate and STAI score from pre-intervention phase to post-intervention phase

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