Surgery
Volume 147, Issue 3 , Pages 318-330.e6 , March 2010

The impact of stress on surgical performance: A systematic review of the literature

  • Sonal Arora, BSc, MBBS

      Affiliations

    • Imperial College, London, United Kingdom
    • Corresponding Author InformationReprint requests: Sonal Arora, BSc, MBBS, Department of Bio-Surgery and Surgical Technology, Imperial College, St Mary's Hospital, 10th Floor, QEQM, South Wharf Road, London W2 1NY, United Kingdom.
  • ,
  • Nick Sevdalis, PhD

      Affiliations

    • Imperial College, London, United Kingdom
  • ,
  • Debra Nestel, PhD

      Affiliations

    • Imperial College, London, United Kingdom
    • Gippsland Medical School, Monash University, Victoria, Australia
  • ,
  • Maria Woloshynowych, PhD

      Affiliations

    • Imperial College, London, United Kingdom
  • ,
  • Ara Darzi, FMedSci, FACS

      Affiliations

    • Imperial College, London, United Kingdom
  • ,
  • Roger Kneebone, PhD

      Affiliations

    • Imperial College, London, United Kingdom

,Accepted 2 October 2009.

References 

  1. Vincent C, Moorthy K, Sarker SK, Chang A, Darzi AW. Systems approaches to surgical quality and safety: from concept to measurement. Ann Surg. 2004;239:475–482
  2. Calland JF, Guerlain S, Adams RB, Tribble CG, Foley E, Chekan EG. A systems approach to surgical safety. Surg Endosc. 2002;16:1005–1014
  3. Aggarwal R, Moorthy K, Darzi A. Laparoscopic skills training and assessment. Br J Surg. 2004;91:1549–1558
  4. Kneebone R. The human face of simulation: patient-focused simulation training. Acad Med. 2006;81:919
  5. Yule S, Flin R, Paterson-Brown S, Maran N. Non-technical skills for surgeons in the operating room: a review of the literature. Surgery. 2006;139:140–149
  6. Undre S, Sevdalis N, Healey AN, Darzi SA, Vincent CA. Teamwork in the operating theatre: cohesion or confusion?. J Eval Clin Pract. 2006;12:182–189
  7. Sevdalis N, McCulloch P. Teaching evidence-based decision-making. Surg Clin North Am. 2006;86:59–70viii
  8. Selye H. The evolution of the stress concept. Am Scientist. 1973;61:692–699
  9. Yerkes RM, Dodson JD. The relation of strength of stimulus to rapidity of habit formation. J Comp Neurol Psychol. 1908;18:459–482
  10. Lazarus RS. The psychology of stress and coping. Issues Ment Health Nurs. 1985;7:399–418
  11. Wetzel CM, Kneebone RL, Woloshynowych M, Nestel D, Moorthy K, Kidd J, et al. The effects of stress on surgical performance. Am J Surg. 2006;191:5–10
  12. Arora S, Sevdalis N, Nestel D, Tierney T, Woloshynowych M, Kneebone R. Managing intraoperative stress: what do surgeons want from a crisis training program?. Am J Surg. 2009;197:537–543
  13. Sevdalis N, Forrest D, Undre S, Darzi A, Vincent C. Annoyances, disruptions, and interruptions in surgery: the Disruptions in Surgery Index (DiSI). World J Surg. 2008;32:1643–1650
  14. Sevdalis N, Healey AN, Vincent CA. Distracting communications in the operating theatre. J Eval Clin Pract. 2007;13:390–394
  15. Campbell DA, Sonnad SS, Eckhauser FE, Campbell KK, Greenfield LJ. Burnout among American surgeons. Surgery. 2001;130:695–702
  16. Berguer R, Smith WD, Chung YH. Performing laparoscopic surgery is significantly more stressful for the surgeon than open surgery. Surg Endosc. 2001;15:1204–1207
  17. Smith WD, Chung YH, Berguer R. A virtual instrument ergonomics workstation for measuring the mental workload of performing video-endoscopic surgery. Stud Health Technol Inform. 2000;70:309–315
  18. The New Intercollegiate Curriculum for Surgical Education. London, UK: Intercollegiate Surgical Curriculum Project; 2005;
  19. Hassan I, Weyers P, Maschuw K, Dick B, Gerdes B, Rothmund M, et al. Negative stress-coping strategies among novices in surgery correlate with poor virtual laparoscopic performance. Br J Surg. 2006;93:1554–1559
  20. Driskell JE, Salas E. Overcoming the effects of stress on military performance; human factors, training and selection strategies. Oxford, UK: Wiley; 1991;
  21. Flin R, O'Connor P, Crichton M. Safety at the sharp end: a guide to non-technical skills. Aldershot, UK: Ashgate; 2008;
  22. Gaba DM, DeAnda A. A comprehensive anesthesia simulation environment: re-creating the operating room for research and training. Anesthesiology. 1988;69:387–394
  23. Holzman RS, Cooper JB, Gaba DM, Philip JH, Small SD, Feinstein D, et al. Anesthesia crisis resource management: real-life simulation training in operating room crises. J Clin Anaeth. 1995;7:675–687
  24. Sachdeva AK, Philibert I, Leach DC, Blair PG, Stewart LK, Rubinfeld IS, et al. Patient safety curriculum for surgical residency programs: results of a national consensus conference. Surgery. 2007;141:427–441
  25. Arnetz BB, Andreasson S, Strandberg M, Eneroth P, Kallner A. Comparison between surgeons and general practitioners with respect to cardiovascular and psychosocial risk factors among physicians. Scand J Work. Environ Health. 1988;14:118–124
  26. Jezova D, Slezak V, Alexandrova M, Motovska Z, Jurankova E, Vigas M, et al. Professional stress in surgeons and artists as assessed by salivary cortisol. In: Stress Neuroendocrine and molecular approaches, Vols. 1991, 1992. Philadelphia, PA: Gordon & Breach Science Publishers; 1992;p. 1953–1962
  27. Kikuchi K, Okuyama K, Yamamoto A, Hara T. Intraoperative stress for surgeons and assistants. J Ophthal Nurs Technol. 1995;14:68–70
  28. Yamamoto A, Hara T, Kikuchi K, Fujiwara T. Intraoperative stress experienced by surgeons and assistants. Ophthal Surg Lasers. 1999;30:27–30
  29. Undre S, Koutantji M, Sevdalis N, Gautama S, Selvapatt N, Williams S, et al. Multidisciplinary crisis simulations: the way forward for training surgical teams. World J Surg. 2007;31:1843–1853
  30. Sexton JB, Thomas EJ, Helmreich RL. Error, stress, and teamwork in medicine and aviation: cross sectional surveys. BMJ. 2000;320:745–749
  31. Becker W, Ellis H, Goldsmith R, Kaye A. Heart rates of surgeons in theatre. Ergonomics. 1983;26:803–807
  32. Bohm B, Rotting N, Schwenk W, Grebe S, Mansmann U. A prospective randomized trial on heart rate variability of the surgical team during laparoscopic and conventional sigmoid resection. Arch Surg. 2001;136:305–310
  33. Czyzewska E, Kiczka K, Czarnecki A, Pokinko P. The surgeon's mental load during decision making at various stages of operations. Eur J Appl Physiol. 1983;51:441–446
  34. Moorthy K, Munz Y, Forrest D, Pandey V, Undre S, Vincent C, et al. Surgical crisis management skills training and assessment: a simulation[corrected]-based approach to enhancing operating room performance. Ann Surg. 2006;244:139–147
  35. Demirtas Y, Tulmac M, Yavuzer R, Yalcin R, Ayhan S, Latifoglu O, et al. Plastic surgeon's life: marvelous for mind, exhausting for body. Plast Reconstr Surg. 2004;114:923–932
  36. Moorthy K, Munz Y, Dosis A, Bann S, Darzi A. The effect of stress-inducing conditions on the performance of a laparoscopic task. Surg Endosc. 2003;17:1481–1484
  37. Tendulkar AP, Victorino GP, Chong TJ, Bullard MK, Liu TH, Harken AH. Quantification of surgical resident stress “on call.”. J Am Coll Surg. 2005;201:560–564
  38. Schuetz M, Gockel I, Beardi J, Hakman P, Dunschede F, Moenk S, et al. Three different types of surgeon-specific stress reactions identified by laparoscopic simulation in a virtual scenario. Surg Endosc. 2008;22:1263–1267
  39. Payne R, Rick J. Heart rate as an indicator of stress in surgeons and anaesthetists. J Psychosom Res. 1986;30:411–420
  40. Heart rate variability. Standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation. 1996;93:1043–1065
  41. Bootsma M, Swenne CA, Van Bolhuis HH, Chang PC, Cats VM, Bruschke AV. Heart rate and heart rate variability as indexes of sympathovagal balance. Am J Physiol. 1994;266:H1565–H1571
  42. Pagani M, Furlan R, Pizzinelli P, Crivellaro W, Cerutti S, Malliani A. Spectral analysis of R-R and arterial pressure variabilities to assess sympatho-vagal interaction during mental stress in humans. J Hypertens Suppl. 1989;7:S14–S15
  43. Boucsein W. Electrodermal activity. New York: Plenum Press; 1992;
  44. Tanida M, Katsuyama M, Sakatani K. Relation between mental stress-induced prefrontal cortex activity and skin conditions: a near-infrared spectroscopy study. Brain Res. 2007;1184:210–216
  45. Speilberger CD, Gorsuch RL. Lushene R. STAI manual. Palo Alto, CA: Consulting Psychologist Press; 1970;
  46. Smith WD, Berguer R, Rosser JC. Wireless virtual instrument measurement of surgeons' physical and mental workloads for robotic versus manual minimally invasive surgery. Stud Health Technol Inform. 2003;94:318–324
  47. Berguer R, Smith W. An ergonomic comparison of robotic and laparoscopic technique: the influence of surgeon experience and task complexity. J Surg Res. 2006;134:87–92
  48. Lee EC, Rafiq A, Merrell R, Ackerman R, Dennerlein JT. Ergonomics and human factors in endoscopic surgery: a comparison of manual vs telerobotic simulation systems. Surg Endosc. 2005;19:1064–1070
  49. Bunch WH, Dvonch VM, Storr CL, Baldwin DC, Hughes PH. The stresses of the surgical residency. J Surg Res. 1992;53:268–271
  50. Zelem JD. Facing the daily grind: how surgeons might cope with burnout. Bull Am Coll Surg. 2007;92:24–26
  51. Klein G. Sources of power. How people make decisions. Cambridge, MA: The MIT Press; 1998;
  52. Klein G. The effects of acute stress on decision making. In:  Driskell JE,  Salas E editor. Stress and human performance. Mahwah, NJ: Erlbaum; 1996;
  53. Lazarus RS. Coping theory and research: past, present, and future. Psychosom Med. 1993;55:234–247
  54. De Cossart LFD. Cultivating a thinking surgeon: new perspectives on clinical teaching, learning and assessment. Shropshire, UK: TFM Publishing; 2005;
  55. Martin JA, Regehr G, Reznick R, MacRae H, Murnaghan J, Hutchison C, et al. Objective Structured Assessment of Technical Skill (OSATS) for surgical residents. Br J Surg. 1997;84:273–278
  56. Sevdalis N, Lyons M, Healey AN, Undre S, Darzi A, Vincent CA. Observational teamwork assessment for surgery: construct validation with expert versus novice raters. Ann Surg. 2009;249:1047–1051
  57. Sevdalis N, Davis R, Koutantji M, Undre S, Darzi A, Vincent CA. Reliability of a revised NOTECHS scale for use in surgical teams. Am J Surg. 2008;196:184–190
  58. Berguer R, Chen CY, Smith WD. A virtual instrument ergonomics workstation to measure surgeons' physical stress. Stud Health Technol Inform. 1999;62:49–54

 Supported by the BUPA Foundation.

PII: S0039-6060(09)00617-5

doi: 10.1016/j.surg.2009.10.007

Surgery
Volume 147, Issue 3 , Pages 318-330.e6 , March 2010