DOI: 10.1093/bjs/znad241.138 ISSN:

SP11.10 Assessment of Heart Rate Variability as A Marker of Stress and Cognitive Load During Vascular Surgery: Surgical Training

Manish Mandal, Calvin De Louche, Lee Fernandes, Jason Lawson, Anna Louise Pouncey, Colin D Bicknell
  • Surgery

Abstract

Introduction

Decreased heart rate variability (HRV) correlates with subjective stress (STAI-6 score) and demonstrates increased stress at challenging steps during vascular surgery. This observational study aimed to examine HRV utility as an objective measure of stress and satisfaction during intra-operative vascular surgical training; hypothesising detrimental HRV change is associated with: (1) low training satisfaction, (2) operating compared to assisting, and (3) lower surgical experience.

Methods

Change from baseline (%) in HRV (SDNN - overall variability and LFHF - sympathetic tone) was calculated during arterial cutdown and arterial closure training points in 7 trainers and 10 trainees during 9 femoral vascular procedures. Pearson’s correlation coefficient was used to investigate association between training satisfaction and operative HRV in trainees, and overall operative experience and training point HRV. Mann-Whitney-U was used to investigate HRV difference in operating trainees with high versus average training satisfaction and operating versus assisting/supervising training points.

Results

Data (median (IQR)) included 13 cutdowns and 12 closures. Training satisfaction did not relate to STAI-6 or HRV. LFHF was significantly lower in trainers when operating (n=2) compared to supervising (n=10) cutdown (-18.96(-27.87--10.05) vs 36.96(10.83-147.2) p=0.0409*). No difference was seen during closure or in trainees. Operative LFHF non-significantly decreased with experience overall (r=-0.342, p=0.0944) and during cutdown (r=-0.498, p=0.0833), no association existed for assisting.

Conclusion

HRV may objectively measure stress during in-theatre training. This study suggests trainers may experience more stress when supervising rather than operating. Larger studies are required to demonstrate a more definitive relationship between training, stress and HRV.

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