Assessing surgeon stress during urological interventions: A descriptive study using heart rate variability (uRRology).

Introduction: In a difficult environment like surgery with continuous exposure to stress, surgeon's health and well-being is affected. The heart rate variability (HRV) is a valid stress indicator. This study aims to provide descriptive data regarding stress during urological intervention using HRV.

Methods: This prospective, unicentric study, included urological interventions from June to December 2023. Surgeons were surveyed on general characteristic, and surgical skills level. Beat-by-beat heart rate (HR) recorded using POLAR A300® chest belt. HRV were analyzed in time (mean HR and the root mean square of successive differences [RMSSD]) and frequency (Fast Fourier transformation spectrum high frequency [FFT spectrum HF]) domain. Their baseline collected outside the operating room, 3 events during intervention examined: incision, closure, and adverse events. Visual stress and difficulty scale during intervention were completed. The differences between baseline and events were calculated.

Results: A total of 171 urological interventions were included. Senior surgeons performed 54 (31.58%) and juniors 117 (68.42%). During interventions, seniors had significantly higher median difference of HR (incision: -11.92 [12.74] bpm versus -2.27 [10.99] bpm for juniors, P≤0.0001; closure: -10.73 [13.71] bpm, versus -4.18 [12.30] bpm for juniors, P=0.0005), lower HF (incision: 0.01 [0.07] hz, versus -0.006 [0.03] hz for juniors P≤0.0001; closure: 0.02 [0.06] hz, versus 0.00 [0.02] hz for juniors, P≤0.0001), and lower RMSSD (incision: -3.34 [13.09] ms for seniors versus -7.63 [10.57] ms for juniors, P=0.0098). No significant difference in RMSSD during closure (P=0.2049).

Conclusion: Study demonstrated the possibility to assess HRV in standard medical practice, senior surgeons experienced more physiological changes during interventions.