A Novel Approach to Quantifying Acute Stress in Cataract Surgeons to Investigate the Relationship Between Surgeon Experience and Intraoperative Stress.

Purpose To quantify intraoperative stress levels in cataract surgeons and investigate the relationship between intraoperative stress and surgeon experience. Setting Department of Ophthalmology, Hanusch Krankenhaus, Vienna, Austria. Design Prospective, observational case series. Methods Five ophthalmologists with surgery experiences of 70 to 15,000 previous surgeries volunteered for this study. Surgeons' heart rate and heart rate variability (HRV) were measured during a total of 45 cataract surgeries. Heart rate and HRV values were normalized to the minimal heart rate and maximal HRV of an overnight baseline measurement. The resulting normalized heart rate measure and HRV stress index are stress dependent and comparable between subjects. No case selection was performed. Results Less experienced surgeons showed higher HRV stress indices; differences between the surgeons with less than 180 and 500 surgeries and the two with 600 and 1,500 surgeries were significant ([alpha] =0.05). No significant difference in stress indices was found between the 1,500 and 15,000 surgeries subjects, suggesting that there may be a plateau effect after 1,500 surgeries. HRV stress indices and case times were negatively correlated with the logarithm of experience in number of previously performed surgeries (r2 = 0.67 and 0.52). No significant stress build-up over multiple successive surgeries was found ([alpha] =0.05). Conclusions The novel HRV stress index is a simple but powerful tool for quantifying intraoperative stress in cataract surgeons. Decreases in stress with increasing experience are congruent with previous works on general surgeon's stress and follow a similar timeline as previously published, proficiency-based learning curves for cataract surgery.