Is Your Surgeon Stressed?

Surgeons experience more stress than they anticipate during endometriosis surgery, study finds.

Key Points

Highlights: 

• Surgeons experience more stress than they anticipated during endometriosis surgery.
• Primary surgeons and surgeons in training experience more stress.

Importance:

• Recognizing the stress experienced by surgeons during endometriosis surgery can ensure implementation of effective stress reduction programs and also ensure stress does not impact performance.

What’s done here:

• The perceived stress and anxiety among endometriosis surgeons were assesed.
• The differences in stress levels between surgeons according to the level of training, the type of surgery they were performing, and their role during surgery were also evaluated.
• Attending and resident gynecologists performing routine elective surgeries were asked to complete a visual analog scale measuring perceived stress before and immediately after completing 161 elective surgeries. 
• A total of 17 surgeons participated in the study (8 attending gynecologists and 9 residents). The residents started as primary surgeons in the majority (69%) of procedures. 

Key results:

• Experienced stress and anxiety were greater than anticipated stress in most cases.
• Residents experienced more anticipatory stress and anxiety than attending gynecologists.
• Primary surgeons experienced more anticipatory stress and anxiety than assistant surgeons.
• Primary surgeons and residents experience greater procedural stress and anxiety than assistants and attending gynecologists. 
• Stress and anxiety were correlated before and during surgery.

Limitations:

• One surgical team conducted most of the gynecological surgeries in this study.
• During the study it was not possible to assess the impact of trainee-attending interactions, familiarity of the surgical team, and the inclusion of a study participant in more than one surgical event per day.
• It was also not possible to describe the significance of a “threat” stimulus or to identify which stimulus may cause a change in the perceived stress.

Lay Summary

Stress during endometriosis surgery among surgeons is greater than what they anticipate, according to a new study published in the scientific journal Acta Obstetricia et Gynecologica Scandinavica. The stress symptoms reported by surgeons start before surgery and is more common among those operating as primary surgeons and surgeons in training. 

The authors of the study said that future studies should focus on factors that increase stress before surgery and pinpoint when these factors start having a detrimental effect on the performance of the surgeon.

Endometriosis surgery is stressful and at times a daunting experience for patients and their families. However, surgeons themselves experience stress before operating on a patient with endometriosis. Since stress can have a direct effect on performance, it is important to be aware of it and recognize it so that effective stress reduction programs can be implemented. 

In the present study, a team of researchers from Australia led by Dr. Jason Abbott from the School of Clinical Medicine at The University of New South Wales and Gynecology Research and Clinical Excellence (GRACE) at the Royal Hospital for Women in Sydney wanted to identify differences between stress and anxiety that surgeons experience before surgery, and their recollection of the stress and anxiety that they experienced during surgery. The team also assessed differences in stress levels between surgeons according to the level of training, the type of surgery they were performing, and their role during surgery.

They asked attending and resident gynecologists performing routine elective surgeries to complete a visual analog scale measuring perceived stress as well as the State-Trait Anxiety Inventory (STAI) before and immediately after completing 161 elective surgeries. A total of 17 surgeons participated in the study. Of these, 8 were attending gynecologists and 9 were residents. The residents started as primary surgeons in the majority (69%) of procedures. 

The results showed that the stress that the surgeons experienced during surgery was greater than what they anticipated in most (57%) surgery episodes.  State anxiety was also greater than anticipated in 62% of episodes. Residents experienced greater preprocedural anticipatory stress and anxiety compared to attending gynecologists. The same was also true for primary surgeons compared to assistant surgeons.  Finally, stress and anxiety during surgery were greater among primary surgeons and residents than among assistants and attending gynecologists. 

The researchers found that stress and anxiety were positively correlated both before and during surgery.

“ . . . the significance of these stress differences observed and how they impact either patient or surgeon health remains unclear,” the researchers highlighted.

Research Source: https://pubmed.ncbi.nlm.nih.gov/38053225/