Study links high surgeon stress, positive patient outcomes

Editor's Note

Optimizing surgeon stress could enhance surgical performance and patient outcomes, according to a large cohort study published January 15 in JAMA Surgery. Researchers focused particularly on physiological markers of surgeon stress during the first 5 minutes of a procedure, revealing a significant inverse relationship with major patient complications.  

The a multicenter prospective study involved 14 surgical departments in France, encompassing 38 experienced surgeons and 793 patients. Surgeon stress was measured using the low-frequency to high-frequency (LF:HF) ratio derived from heart rate variability (HRV), a marker of sympathovagal balance. This ratio, normalized for each surgeon, served as the primary metric for physiological stress. Patient outcomes, including major complications, ICU stays, and 30-day mortality, were tracked and adjusted for variables such as patient comorbidities, surgeon experience, and procedure complexity.

Results show a higher LF:HF ratio at the start of surgery correlated with a 37% reduction in major complications (adjusted odds ratio [AOR], 0.63; 95% CI, 0.41-0.98; P = .04). Although ICU stays and mortality showed trends toward improvement, these associations lost statistical significance after adjustment.

The findings highlight the nuanced relationship between stress and performance, researchers write. Moderate stress levels may enhance cognitive focus and technical execution, particularly among experienced surgeons, aligning with prior research in fields such as athletics. However, excessive stress or inexperience may yield adverse effects. The initial moments of surgery, less influenced by intraoperative events, are critical for evaluating stress impacts.

Researchers call for replicating the findings in randomized trials and broader populations, as well as further study into balancing surgeon stress optimization with long-term health.