A wearable approach for intraoperative physiological stress monitoring of multiple cooperative surgeons. (September 2019)

• Record Type: Journal Article
• Authors: Pimentel, Gonçalo; Rodrigues, Susana; Silva, Pedro Alberto; Vilarinho, António; Vaz, Rui; Silva Cunha, João Paulo
• Is Part Of: International journal of medical informatics. Volume 129(2019)
• Page Start: 60
• Page End: 68
• Publication Date: 2019-09
• Subjects: Physiological monitoring -- Neurosurgeons -- Stress -- Wearable systems -- Heart rate variability; Medical informatics -- Periodicals; Information science -- Periodicals; Computers -- Periodicals; Medical technology -- Periodicals; Medical Informatics -- Periodicals; Technology, Medical -- Periodicals; Computers; Information science; Medical informatics; Medical technology; Electronic journals; Periodicals; Electronic journals; 610.285
• DOI: 10.1016/j.ijmedinf.2019.05.028
• Languages: English
• ISSNs: 1386-5056

Abstract

Graphical abstract: This study illustrates the use of a wearable biomonitoring platform for the assessment of stress among neurosurgeons during surgery procedures. Highlights: Role switching among neurosurgeons seems to induce a measurable change in autonomic balance. Surgeon main role is exposed to high levels of stress when performing demanding procedures. Cognitive workload is related with stress appraisal, more mentally demanding procedures are assessed as more stressful. Wearable biomonitoring platform as a useful tool for stress assessment and differentiation. Abstract: It is known that excessive levels of occupational stress affect professionals' technical and non-technical skills and surgeons are no exception. However, very few studies address this problem in neurosurgeons. A system for monitoring cardiovascular strain and autonomic imbalance during intracranial aneurysm procedures is proposed in order to obtain overall cardiac measures from those procedures. Additionally, this study also allows to detect stressful events and compare their impact with the surgeon's own appraisal. Linear and nonlinear heart rate variability (HRV) features were extracted from surgeon's electrocardiogram (ECG) signal using wearable ECG monitors and mobile technology during 10 intracranial aneurysm surgeries with two surgeons. Stress appraisal and cognitive workload were assessed using self-report measures. Findings suggest that the surgeon associated to the main role during the clipping can be exposed to high levels of stress, especially if a rupture occurs (pNN20 = 0%), while the assistant surgeon tends to experience mental fatigue. Cognitive workload scores of one of the surgeons were negatively correlated with AVNN, SDNN, pNN20, pNN50, 1 V, 2 L V, SD2 and CVI measures. Cognitive workload was positively related with stress appraisal, suggesting that more mentally demanding procedures are also assessed as more stressful. Finally, pNN20 seems to better mirror behavior during stress moments than pNN50. Additionally, a sympathovagal excitation occurs in one of the professionals after changing to main role. The present methodology shows potential for the identification of harmful events. This work may be of importance for the design of effective interventions in order to reduce surgeons stress levels. Furthermore, this approach can be applied to other professions.