Attending Stress Levels In Supervising Residents During Cataract Surgery

Intraoperative stress levels have been studied in residents performing cataract surgery, with only one study previously published investigating heart rates in three ophthalmic staff surgeons (Sadiq et al., 2013). Stress in any surgical field can affect outcomes and in obtaining confidence for surgical trainees. Due to the limited literature on intraoperative stress in cataract surgery, our study investigates fluctuations in heart rates for staff at our centre at each step of the surgery, both when supervising residents and as the primary surgeon operating. 

Single centre, prospective, observational clinical outcomes study.

Two healthy male ophthalmic surgeons with a total of 23 cases had a chest-strapped Bluetooth device recording their heart rate during an entire day in the operating room. Heart rate data from the Bluetooth device were corresponded to each step of the cataract surgery. Only data from uncomplicated surgeries were included. The mean, minimum, and maximum heart rates, as well as the change from baseline heart rate were compared among both attending surgeons.

The highest mean heart rates were during phacoemulsification and lens insertion, both with a mean of 82.8 bpm, followed by irrigation and aspiration with a mean of 82.3 bpm. Irrigation and aspiration had the most significant change from the baseline heart rate at the start of the case, followed by lens insertion. There was no statistically significant difference in heart rate between observing the resident physician compared to being the primary surgeon operating.  

This study demonstrates that certain steps of cataract surgery such as phacoemulsification, irrigation and aspiration, and lens insertion can be associated with a more significant change in heart rate and thus greater stress levels. Further data are being collected to confirm if these steps of the surgery are associated with an elevated heart rate in a greater number of surgeons at our centre. This can help determine if stress-reducing measures impact heart rates intra-operatively and emphasize areas where residents may require further training in the wet lab or on simulators when preparing for cataract surgery. 

Reference:

Sadiq, S. A., Arif, A., & Usmani, H. A. (2013). The stress of cataract surgery. J Clin Exp Ophthalmol, 4(301), 2.