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First Author: H.Usmani UK
Co Author(s): A. Arif S. Sadiq
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To assess the stress levels of three different grades of ophthalmic surgeons during cataract surgery.
Manchester Royal Eye Hospital, Manchester, United Kingdom
In this prospective observational study, using a pulse oximeter, the heart rates of three ophthalmic surgeons (Surgeon A- a specialty trainee, Surgeon B, a cataract surgery fellow and Surgeon C, a non-anterior segment consultant ) were measured during each stage of 95 consecutive, uncomplicated, local anaesthetic cataract surgery procedures. The baseline heart rate was noted and then recorded every 2 seconds during the operation. An observer masked to the heart rate noted the time for each of the stages of the operation. The mean heart rate from the beginning to the completion of each stage was subtracted from the baseline and the percentage was calculated. This was compared for different stages of the procedure for individual surgeons and amongst the three surgeons using the one-way ANOVA test.
Observations were recorded on 29 cases for Surgeon A and 33 cases each for Surgeon B and Surgeon C. The percent change in heart rate was different for each surgeon for each stage of the procedure [incision (p=0.455), capsule rhexis (p=0.007), hydrodissection (p=0.031), phacoemulsification (p=0.000), irrigation & aspiration (p=0.018), intraocular lens implantation (p=0.002) and wound closure (p=0.149)]. Surgeon A showed highest elevation from the baseline during phacoemulsification (p<0.001). Surgeon B did not show a significant difference between stages (p=0.103); and Surgeon C had a higher heart rate towards the completion of the procedure (p<0.001).
Published reports have highlighted the stress surgeons in different specialties undergo. Ours was the first study to look at the heart rates of cataract surgeons of different grades to assess their stress levels. We demonstrate a statistically significant difference in the change of heart rate from the baseline between the 3 surgeons. We feel this change can be translated to reflect the degree of stress a surgeon undergoes whilst performing cataract surgery, and may be attributed to the difference between their experience and skills. Further studies can be undertaken to better identify stages of greater stress and means to reduce it.