The separate and combined effect of intraoperative stressors on the surgical team during burn surgery: A pilot study

Burn injuries occurring to more than 20 % of a patient's total body surface area (TBSA) are often treated in hot theatres and are considered complex cases, potentially increasing stress in the surgical staff. While heat stress is known to affect perceived workload and cognitive function, the effect of psychological stress, and the combined effect of heat and psychological stress, have not been explored in surgical staff. Thus, our aim was to assess the separate and combined effects of heat and psychological stress on cognitive function, perceptual measures, and physiological variables of surgical staff during burn surgery.

Eight surgical personnel were assessed in control conditions: CON (24 ± 1°C; 7 ± 10 % TBSA), hot conditions: HOT (30 ± 1°C; 18 ± 2 % TBSA), and complex, hot conditions: HOT_C (32 ± 1°C; 37 ± 23 % TBSA). Cognitive function and perception of thermal sensation and comfort were recorded pre- and post-surgery, while perceived workload was assessed post-surgery only. Physiological variables were recorded throughout surgery.

Working memory capacity pre-surgery (g=0.38) and processing speed were impaired in HOT_C compared to CON (p < 0.05), but were not different between HOT and CON (p > 0.05). Perceived workload was higher in HOT_C compared to CON (p < 0.05) but was not different between HOT and CON (p > 0.05). Numerical differences in core temperature between HOT_C and CON were larger than differences between HOT and CON, while heart rate was significantly higher in HOT_C compared to HOT or CON (p < 0.05).

Heat stress can cause symptoms of heat strain in the surgical team, which can be exacerbated by psychological stress, potentially leading to cognitive impairments and a higher perceived workload.