ArticleInternational archives of occupational and environmental health2014
Heart rate and heart rate variability as indirect markers of surgeons' intraoperative stress.
Article in International archives of occupational and environmental health, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 55 papers, 4 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
55 citing papers in PubMed, 4 syntheses or guidelines pooled it, 107 citations in OpenAlex.
- Stress in surgical educational environments: a systematic review.BMC medical education · 2022Pooled it
- Heart rate variability as a measure of mental stress in surgery: a systematic review.International archives of occupational and environmental health · 2020Pooled it
- Heart rate variability and occupational stress-systematic review.Industrial health · 2018Pooled it
- Systematic review of measurement tools to assess surgeons' intraoperative cognitive workload.The British journal of surgery · 2018Pooled it
- Physiological correlates of cognitive load in laparoscopic surgery.Scientific reports · 2020Trial
- Impact of single-incision laparoscopic cholecystectomy (SILC) versus conventional laparoscopic cholecystectomy (CLC) procedures on surgeon stress and workload: a randomized controlled trial.Surgical endoscopy · 2016Trial
- Intra-operative disruptions, surgeon's mental workload, and technical performance in a full-scale simulated procedure.Surgical endoscopy · 2016Trial
- Daily Stress and Heart Rate Variability Among Mindfulness Meditation Practitioners: mHealth Observational Study.Journal of medical Internet research · 2026Observational
- Evaluating surgeons' stress using heart rate variability during minimally invasive surgery for gastric cancer: a single-center prospective cohort study.Langenbeck's archives of surgery · 2026Article
- A Systematic Review and Meta-Analysis of Heart Rate Variability in Assessing Surgeons' Stress Levels.Healthcare (Basel, Switzerland) · 2026Review
- A study protocol for a systematic review and meta-analysis on macroscopic body movements as a marker for acute stress.Systematic reviews · 2026Article
- The impact of intraoperative optical coherence tomography on cognitive load in virtual reality vitreoretinal surgery training.Scientific reports · 2025Article
- Heart rate and heart rate variability during diagnostic and interventional neuroendovascular procedures.Interventional neuroradiology : journal of peritherapeutic neuroradiology, surgical procedures and related neurosciences · 2025Article
- Association between heart rate variability and ECG changes in on-duty prehospital physicians.Frontiers in physiology · 2025Article
- Using mobile EEG to study auditory work strain during simulated surgical procedures.Scientific reports · 2024Article
- Heart rate variability as a dynamic marker of surgeons' stress during vascular surgery.BJS open · 2024Article
- Applying augmented reality in teaching of surgical residents-telementoring, a "stress-free" way to surgical autonomy?Langenbeck's archives of surgery · 2024Article
- Cognitive ergonomics and robotic surgery.Journal of robotic surgery · 2024Review
- Energy Consumption and Substrate Utilization During Spinal Surgery.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2024Article
- Psychosocial Stress Modifies the Acute Cardiac Health Effects of Traffic-Related Air Pollution.Environment & health (Washington, D.C.) · 2024Article
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveIn a difficult and demanding environment such as the operating room, the individual workload response of physicians is of particular importance. The aim of this study was to examine the specific effects of intraoperative stress on the cardiovascular system by measuring heart rate (HR) and heart rate variability (HRV).
methodsIn a cross-sectional study, the effect of intraoperative stress on autonomic balance, measured by HRV, among surgeons differing with respect to their intraoperative stress levels was studied. Based on their perceived stress (State Trait Anxiety Inventory), surgeons were classified into a stressed and a non-stressed sample. Data on HR and HRV were collected by means of ambulatory ECG-recordings. Changes in autonomic nervous system activity were quantified by frequency and time domain analysis of R-R interval variability. Demographic, anthropometric, and surgery-related group differences were assessed by non-parametric Mann-Whitney U test, differences between relative changes of HR and HRV by Wilcoxon signed-ranks test. In multivariate linear analysis of covariance, group differences were adjusted for possible confounding factors.
resultsThere was a significant difference in intraoperative HR for stressed and non-stressed surgeons (median: 99.3 vs. 63.7; P < 0.05). During sleep, HRV indices indicated a reduced autonomic recovery in stressed participants.
conclusionsOur results reveal that higher perceived stress in the operating room is associated with increased intraoperative HR and decreased HRV at night. Non-stressed surgeons show greater relaxation during sleep compared to their stressed colleagues.
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