Physiological and psychological responses to surgery and non-surgery days in orthopaedic surgeons: A case study

Objective: Performing surgical procedures can increase the physiological stress and mental strain experienced by practicing surgeons. This may affect negatively work capacity and quality of patient care by increasing the incidence of burnout, sleep disorders, fatigue and substance abuse. The purpose of this pilot case study was to track physiological and psychological responses to clinical duties in an expert arthroplasty orthopaedic surgeon.Methods: Heart rate (HR), breathing rate, heart rate variability (HRV) and anxiety ratings were observed in an expert orthopaedic surgeon using a wearable Equivital EQO2 physiological monitor and the state-trait anxiety inventory (STAI), respectively. Data was recorded for 8 surgery, 1 clinic and 1 rest day. Physiological data was recorded for 6-8 hours/day.Results: The surgeon spent significantly more time with elevated HRs on surgery days versus either clinic or rest days (10% of the day over 100 bpm). This was not the case for respiratory rate. STAI responses were significantly greater pre versus post surgery and at baseline. Psychological and physiological markers of stress were elevated prior to each surgery regardless of surgery type and task. Notably, the HR never returned to baseline on surgery days.Discussion: This study provides a baseline on which to compare procedural and trainee differences during surgical procedures. Expert surgeons may demonstrate elevated stress levels on days of surgery, as indicated by self-reported anxiety scores as well as physiologic measures. Understanding the stress and anxiety present may direct interventions that enable improved surgeon health, surgical performance, and an improved learning environment.