How Does Surgeons’ Autonomic Physiology Vary Intraoperatively? A Real-time Study of Cardiac Reactivity
Kareena del Rosario, Tessa V. West, Wendy Berry Mendes, Basir Kunduzi, Nizam Mamode, Petrut Gogalniceanu- Surgery
Objective:
Physiologic responses of surgery team members under varying levels of intraoperative risk were measured.
Background:
Measurement of intraoperative physiological responses provides insight into how operation complexity, phase of surgery, and surgeon seniority impact stress.
Methods:
Autonomic nervous system responses (interbeat intervals, IBIs) were measured continuously during operations. Role (attending surgeon, surgical resident, operating room nurse), risk of operation (high, low), and primary operator (attending surgeon, resident) predicted IBI reactivity. Physiologic synchrony captured the degree of correspondence between individuals’ physiologic responses within timepoint.
Results:
10,005 observations of IBI reactivity were recorded in 26 participants during 16 high-risk (renal transplant and laparoscopic donor nephrectomy) and low-risk (arteriovenous fistula formation) operations. Attending surgeons showed greater IBI reactivity (faster heart rate) than residents and nurses during high-risk operations and while actively operating (
Conclusion:
Attending surgeons’ physiologic responses were well-calibrated to operative demands, and residents’ and nurses’ responses were not, suggesting that risk sensitivity is an adaptive response to stress that surgeons acquire.