{"id":27666,"date":"2025-03-28T04:10:00","date_gmt":"2025-03-27T20:10:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=27666"},"modified":"2025-03-28T05:52:28","modified_gmt":"2025-03-27T21:52:28","slug":"jama-surg%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87%ef%bc%9a%e5%a4%96%e7%a7%91%e5%8c%bb%e7%94%9f%e7%b2%be%e7%a5%9e%e5%8e%8b%e5%8a%9b%e4%b8%8e%e6%89%8b%e6%9c%af%e5%b9%b6%e5%8f%91%e7%97%87%e7%9a%84%e7%9b%b8","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=27666","title":{"rendered":"[JAMA Surg\u53d1\u8868\u8bba\u6587]\uff1a\u5916\u79d1\u533b\u751f\u7cbe\u795e\u538b\u529b\u4e0e\u624b\u672f\u5e76\u53d1\u75c7\u7684\u76f8\u5173\u6027"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

January 15, 2025<\/p>\n\n\n\n

Association Between Surgeon Stress and Major Surgical Complications<\/h1>\n\n\n\n

Jake Awtry, Sarah Skinner, Stephanie Polazzi, et al<\/h3>\n\n\n\n

JAMA Surg. <\/em>Published online January 15, 2025. doi:10.1001\/jamasurg.2024.6072<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  Is surgeon physiological stress, as deduced from the sympathovagal balance measured via heart rate variability analysis, associated with patient outcomes?<\/p>\n\n\n\n

Findings<\/strong>  In this cohort study including 38 attending surgeons and 793 patients, increased surgeon stress in the first 5 minutes of surgery was associated with a significant reduction in major surgical complications after controlling for patient, surgeon, and surgery characteristics.<\/p>\n\n\n\n

Meaning<\/strong>  These results suggest that optimizing surgeon stress may offer an avenue to improve surgical performance, with increased stress benefitting patient outcomes for experienced surgeons.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Surgeon stress can influence technical and nontechnical skills, but the consequences for patient outcomes remain unknown.<\/p>\n\n\n\n

Objective<\/strong>  To investigate whether surgeon physiological stress, as assessed by sympathovagal balance, is associated with postoperative complications.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This multicenter prospective cohort study included 14 surgical departments involving 7 specialties within 4 university hospitals in Lyon, France. Exclusion criteria consisted of patient age younger than 18 years, palliative surgery, incomplete operative time-stamping data, procedures with a duration of less than 20 minutes, and invalid surgeon heart rate variability (HRV) data. Data were accrued between November 1, 2020, and December 31, 2021, with 30-day follow-up completed on May 8, 2022. Analyses were performed from January 1 to May 31, 2024.<\/p>\n\n\n\n

Exposure<\/strong>  Sympathovagal balance of the attending surgeon in the first 5 minutes of surgery.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  Major surgical complications, extended intensive care unit stay, and mortality within 30 days, after adjustment via mixed-effects multivariable logistic regression for surgeon age, professional status, the time of incision, the random effect of the surgeon, and a composite risk score incorporating patient comorbidities and surgery characteristics. Sympathovagal balance was quantified by the low frequency to high frequency (LF:HF) ratio derived from HRV data measured by chest monitors worn intraoperatively. The LF:HF ratio was normalized at the surgeon level to the median value observed for each surgeon during the study period to control for baseline differences.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0A total of 793 surgical procedures performed by 38 attending surgeons were included in the analysis. Median patient age was 62 (IQR, 47-72) years, and 412 (52.0%) were female, with a median of 2 (IQR, 1-4) comorbidities. Median surgeon age was 46 (IQR, 39-52) years, 39 (78.9%) were male, and 22 (57.9%) were professors. Median surgeon heart rate was 88 (IQR, 77-99) beats per minute. Median surgeon LF:HF ratio was 7.16 (IQR, 4.52-10.72) before and 1.00 (IQR, 0.71-1.32) after normalization. Increased surgeon sympathovagal balance during the first 5 minutes of surgery was associated with significantly reduced major surgical complications (adjusted odds ratio [AOR], 0.63; 95% CI, 0.41-0.98;\u00a0P<\/em>\u2009=\u2009.04), though not with reduced intensive care unit stay (AOR, 0.34; 95% CI, 0.11-1.01;\u00a0P<\/em>\u2009=\u2009.05) or mortality (AOR, 0.18; 95% CI, 0.03-1.03;\u00a0P<\/em>\u2009=\u2009.05).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  Increased surgeon stress at the beginning of a procedure was associated with improved clinical patient outcomes. The results are illustrative of the complex relationship between physiological stress and performance, identify a novel association between measurable surgeon human factors and patient outcomes, and may highlight opportunities to improve patient care.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  January 15, 2025 […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27666"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=27666"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27666\/revisions"}],"predecessor-version":[{"id":27978,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/27666\/revisions\/27978"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=27666"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=27666"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=27666"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}