Assessing surgeon stress during urological interventions: A descriptive study using heart rate variability (uRRology)

In a difficult environment like surgery with continuous exposure to stress, surgeon's health and well-being is affected. The heart rate variability (HRV) is a valid stress indicator. This study aims to provide descriptive data regarding stress during urological intervention using HRV.

This prospective, unicentric study, included urological interventions from June to December 2023. Surgeons were surveyed on general characteristic, and surgical skills level. Beat-by-beat heart rate (HR) recorded using POLAR A300® chest belt. HRV were analyzed in time (mean HR and the root mean square of successive differences [RMSSD]) and frequency (Fast Fourier transformation spectrum high frequency [FFT spectrum HF]) domain. Their baseline collected outside the operating room, 3 events during intervention examined: incision, closure, and adverse events. Visual stress and difficulty scale during intervention were completed. The differences between baseline and events were calculated.

A total of 171 urological interventions were included. Senior surgeons performed 54 (31.58%) and juniors 117 (68.42%). During interventions, seniors had significantly higher median difference of HR (incision: -11.92 [12.74] bpm versus -2.27 [10.99] bpm for juniors, P≤0.0001; closure: -10.73 [13.71] bpm, versus -4.18 [12.30] bpm for juniors, P=0.0005), lower HF (incision: 0.01 [0.07] hz, versus -0.006 [0.03] hz for juniors P≤0.0001; closure: 0.02 [0.06] hz, versus 0.00 [0.02] hz for juniors, P≤0.0001), and lower RMSSD (incision: -3.34 [13.09] ms for seniors versus -7.63 [10.57] ms for juniors, P=0.0098). No significant difference in RMSSD during closure (P=0.2049).

Study demonstrated the possibility to assess HRV in standard medical practice, senior surgeons experienced more physiological changes during interventions.