Key result
Surgical teaching interventions significantly increased stress levels among cardiac surgical residents compared to non-surgical activities, indicated by a reduced mean RR interval (675.7 ms vs. 777.3 ms).
Why the study?
This pilot study aimed to evaluate cardiac surgical residents workload during different surgical teaching interventions and compare their stress levels to time spent working in the intensive care unit or normal ward.
Does performing surgical activities increase objective stress levels measured by heart rate variability in cardiac surgical residents compared to non-surgical activities?
Observational (n=2)
No
Does performing surgical activities increase objective stress levels measured by heart rate variability in cardiac surgical residents compared to non-surgical activities?
Absolute Event Rate: 675.7% vs 777.3%
p-value: p=<0.001
Cardiac surgical residents experience significantly higher objective psychological stress and workload during surgical procedures compared to non-surgical clinical duties.
Hypothesis-generating for stress mitigation in surgical training; larger trials needed before practice change.
BACKGROUND: The aim of this Pilot study was to investigate the cardiac surgical residents' workload during different surgical teaching interventions and to compare their stress levels with other working time spent in the intensive care unit or normal ward. METHODS: The objective stress was assessed using two cardiac surgical residents' heart rate variability (HRV) both during surgical activities (32 selected teaching operations (coronary artery bypass graft n = 26 and transcatheter aortic valve implantation n = 6), and during non-surgical periods. Heart rate, time and frequency domains as well as non-linear parameters were analyzed using the Wilcoxon test. RESULTS: The parasympathetic activity was significantly reduced during the surgical phase, compared to the non-surgical phase: Mean RR (675.7 ms vs. 777.3 ms), RMSSD (23.1 ms vs. 34.0 ms) and pNN50 (4.7% vs. 10.6%). This indicates that the residents had a higher stress level during surgical activities in comparison to the non-surgical times. The evaluation of the Stress Index during the operations and outside the operating room (8.07 vs. 10.6) and the parasympathetic nervous system index (- 1.75 to - 0.91) as well as the sympathetic nervous system index (1.84 vs. 0.65) confirm the higher stress level during surgery. This can be seen too used the FFT Analysis with higher intraoperative LF/HF ratio (6.7 vs. 3.8). CONCLUSION: HRV proved to be a good, objective method of identifying stress among physicians both in and outside the operating room. Our results show that residents are exposed to high psychological workloads during surgical activities, especially as the operating surgeon.
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Awad et al. (2022) conducted an observational in Cardiac surgical residents (n=2). Surgical teaching interventions vs. Non-surgical medical activities was evaluated on Mean RR interval (p=<0.001). Surgical teaching interventions significantly increased stress levels among cardiac surgical residents compared to non-surgical activities, indicated by a reduced mean RR interval (675.7 ms vs. 777.3 ms).
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