Surgical paradox: physiological activation and improved mood state during surgical work in pediatric surgeons

Pediatric surgeons often experience physical and psychological strain. However, surgery may provide motivation and fulfillment. To explore this dual nature of surgical work, we examined physiological and psychological stress responses of pediatric surgeons on surgical working days (SWs) and nonsurgical working days (NSWs).

Nineteen pediatric surgeons participated in this cross-sectional study. Salivary cortisol, autonomic nervous activity using a wearable device (low/high heart rate ratio [LHR]), and total mood disturbance (TMD) score, calculated from subscales of the Profile of Mood States 2nd Edition (POMS2) as an index of mood state, were assessed at 2 time points: before and after surgery by the operator on SWs (mean preoperative time: 11:16 am; mean postoperative time: 2:18 pm) and at 8:00 am and 5:00 pm on NSWs. Data were analyzed using mixed linear models and univariate tests to evaluate the influence of sex, post-call status, experience, and surgical site.

On both SWs and NSWs (54 and 44 evaluation sessions from 19 pediatric surgeons, respectively), the post-work decrease in cortisol levels was smaller on SWs than on NSWs (P < .05). LHR increased significantly after surgery (SWs) but not on NSWs (P < .05), indicating a sympathetically activated state, particularly remarkable in post-call status compared with non-post-call status (P < .05). TMD scores were lower on SWs than on NSWs (P < .05), reflecting improved mood during surgical activity. More experienced surgeons (>5 years) had lower TMD scores for both SWs and NSWs (P < .05).

Despite physical and psychological demands, performing surgery was linked to reduced mood disturbance among pediatric surgeons.