Surgical stress: Cortisol and anxiety in surgeons, patients, and stretcher-bearers

Daily stress can cause detrimentally high circulating levels of cortisol. Although habituation to this response can occur, it does not necessarily mean resilience. The operating room may be a natural site for the study of stress. Objective: The aim of the present study was to compare the impact of surgical stress in three protagonists of the operating room who play different roles: surgeon, patient, and stretcher-bearer. Methods: Twelve triads (patient, stretcher-bearer, and surgeon) of volunteers were selected. Urine samples were taken to determine the level of urinary cortisol as an indicator of stress. The state-trait anxiety inventory (STAI) was applied in all subjects before surgery. Results: The statistical analysis indicated that surgeons had the highest urinary cortisol levels, with no difference in cortisol levels between stretcher-bearers and patients. No differences in scores on the STAI-State (which evaluates the level of anxiety in response to a contingency) were found among the three experimental groups, and the lowest STAI-Trait scores (which evaluate anxiety as a personality trait) were found in surgeons. Conclusion: These data suggest that surgeons, through years of professional practice, develop a certain degree of resilience to perceived anxiety, but this resilience does not prevent the elevation of biochemical markers of anxiety. Therefore, although outward signs of anxiety are not manifest, strategies should be implemented to reduce anxiety in this group of professionals.