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The effects of stress on surgical performance: a systematic review

Adam Tam^1,2, Samuel Bateman³, Gavin Buckingham³

¹Department of Surgery, Royal Cornwall Hospitals NHS Trust, Truro, UK. at930@exeter.ac.uk.

Surgical Endoscopy

|December 3, 2024

Abstract

Introduction:

Acute stress, the psychological response to short-term challenging stimuli, is frequently encountered in the high-pressure environment of the operating theatre. Surgeon stress is associated with deterioration in surgical performance, surgical team working and compromised patient safety. Given these concerns, the aim of this review was to understand the impact of acute stress on surgical performance in technical and non-technical domains as well as patient outcomes.

Methods:

A systematic review was conducted following PRISMA guidelines. Electronic databases were searched for studies examining acute stress in medical professionals during real or simulated surgical procedures that reported performance outcomes in technical and non-technical skills. Risk of bias assessment was conducted using appropriate tools for each study design.

Results:

Out of 1445 identified studies, 19 met the inclusion criteria. In simulated environments, acute stress consistently led to impairment in both technical and non-technical skills during surgical procedures. Technical skill deterioration included higher procedural error rates, longer task completion times and diminished instrument handling. Non-technical skills, such as teamwork and communication, also were impaired under stress conditions. Real-world studies echoed these findings, demonstrating acute stress resulting in higher error rates and impaired non-technical skills. No studies identified surgeon stress as having a causal relationship with patient outcomes.

Conclusion:

Acute stress significantly impacts both technical and non-technical skills during surgical procedures, impairing performance in simulated and real-world surgical environments. Despite the growing understanding of the detrimental effects of stress, gaps remain in comprehensively assessing its impact on patient outcomes. Further research is warranted to develop reliable stress measurement methods applicable in surgical settings and explore effective stress management strategies.

Keywords:

Acute stress Non-technical skills Surgical performance Technical skills

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