Physiological Responses During Phacoemulsification Cataract Surgery and Perceived Stress Among Ophthalmology Trainees: A Cross-Sectional Study

Background: Intraoperative stress can adversely affect surgical performance and trainee well-being, particularly in ophthalmic surgeries where micro-level precision plays a paramount role. This study aimed to evaluate both subjective measures of general perceived stress and objective physiological responses during phacoemulsification cataract surgery among ophthalmology trainees. Materials and Methods: In this cross-sectional study, 59 ophthalmology residents and fellows were enrolled. Objective physiological responses, including systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), and arterial oxygen saturation (SpO 2 ), were recorded before and during key steps of surgery (incision, capsulorhexis, and lens removal with intraocular lens (IOL) implantation) by an ambulatory electrocardiograph (ECG) device. General perceived stress was also assessed during the preoperative resting period using the 14-item perceived stress scale (PSS-14). Results: SBP and HR increased significantly throughout the surgical steps, with the highest values observed during lens removal and IOL implantation (all P 0.05). Less experienced trainees demonstrated higher overall DBP trends compared to more experienced counterparts ( P = 0.01). Based on PSS-14 scores, female surgeons and those with lower levels of training reported significantly higher perceived stress ( P = 0.04 and P < 0.001, respectively). Pre-operative propranolol use was associated with lower perceived stress ( P = 0.02), although it did not significantly affect physiological parameters. Conclusion: Physiological responses in ophthalmology trainees increase during phacoemulsification cataract surgery, which may be translated into higher intra-operative stress. This increase is particularly higher in later stages, and is influenced by experience level and individual factors. As a result, these findings underscore the importance of implementing targeted strategies to enhance ophthalmology trainee well-being and improve surgical training environments, especially for individuals more susceptible to elevated stress levels. Keywords: stress, trainee, phacoemulsification, cataract, heart rate, PSS-14