Table 3.
Comparative studies on cardiovascular effects of surgery on surgeons
| Study | Specialty | Subjects and cases | Methodology | Aims | Stress measuring instrument | Authors’ conclusions | Limitations |
|---|---|---|---|---|---|---|---|
| Sharma et al. [14] | Neurosurgery | 5 consultant-trainer surgeons; 11 cases total: 10 aneurysm clippings and 1 schwannoma | Prospective study | 1. To compare intraoperative pulse and BP recordings with rest and exercise values in neurosurgeons | 1. Oscillometric monitor | 1. Neurosurgery can induce a significant hemodynamic malresponse in the consultant-trainer that exceeds those induced by vigorous physical activity | 1. Small sample size 2 Did not report any effect of independent operating 3. Single separate operation should be excluded |
| Song et al. [15] | Cardiothoracic surgery | 1 consultant-trainer surgeon; 50 cases total: coronary artery bypass grafting | Prospective study | 1. To determine HR variability of the consultant-trainer as a measure of mental strain 2. To determine whether there were differences in the HR variability when the consultant-trainer performed coronary artery bypass grafting versus when he assisted registrar-trainees |
1. Holter electrocardiogram | 1. When leading, the consultant-trainer’s HR variability was the highest at the beginning of the operation and slowly trended down toward the end 2. When assisting, the consultant-trainer’s HR variability was the highest when the registrar-trainee was performing the most crucial part of the procedure |
1. No control – study assessed HR variability of a single consultant-trainer 2. Only HR variability measured as assessment of cardiovascular system 3. Did not report any effect of independent operating |
| Current study | Orthopaedic surgery | 3 consultant-trainer surgeons and 3 registrar-trainee surgeons; 21 elective cases total: 7 hallux valgus, 7 TKAs, and 7 THAs | Prospective study | 1. To quantify the intraoperative variations in BP of orthopaedic surgeons 2. To assess the variations in BP of the lead consultant-trainer in comparison to when the same individual is assisting a registrar-trainee 3. To assess the variations in BP of the lead registrar-trainee in comparison to when the same individual is assisting a consultant-trainer 4. To assess the effect on BP when the registrar-trainee was operating independently |
1. Ambulatory BP monitor | 1. All surgeons had higher BP and HR readings on operating days compared with baseline 2. When the consultant-trainer was leading, the BP gradually increased until implant placement 3. When the registrar-trainee was leading and the consultant-trainer assisting, the consultant-trainer’s BP peaked at the beginning of the procedure and slowly declined as it progressed; the registrar-trainee’s BP remained elevated throughout. 4. The highest peaks for registrar-trainees were noted during independent operating. |
1. Small sample size 2. Study was not powered 3. No statistical analysis 4. Difference in years of training for consultant-trainer surgeons |
BP = blood pressure; HR = heart rate.