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Intraoperative real-time stress in degenerative lumbar spine surgery: simultaneous analysis of electroencephalography signals and heart rate variability: a pilot study

 Ji-Won Kwon  ;  Sahyun Sung  ;  Soo-Bin Lee  ;  Hwan-Mo Lee  ;  Seong-Hwan Moon  ;  Byung Ho Lee 
 SPINE JOURNAL, Vol.20(8) : 1203-1210, 2020-08 
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Electroencephalography ; Heart rate variability ; Intraoperative stress ; Spine surgery ; Surgeon ; Wearable device
Background context: Interest in intraoperative stress has increased due to its potentially detrimental impact on surgical performance and burnout among spine surgeons.

Purpose: The purpose of this study was to analyze intraoperative stress in real time in terms of electroencephalography signals and heart rate variability using a wearable device during spine surgery.

Study design: Prospective observational study.

Patient sample: Five orthopedic spine surgeons with experience ranging from 1 to 30 years were included.

Outcome measures: The outcome measures included stress levels among the spine surgeons and differences in stress parameters between novice and expert surgeons and between assistants and operators.

Methods: From June 2018 to November 2018, 179 consecutive records of intraoperative stress measures, including intraoperative electroencephalography signals and heart rate variability, comprising beats per minute (BPM) and low frequency/high frequency ratio, for the orthopedic spine surgeons were prospectively gathered, compared, and analyzed.

Results: Among all measures, sensory-motor rhythm (SMR) waves, gamma waves, and BPM differed significantly during surgery (analysis of variance; p=.040, .013, .002, respectively). Surgery duration and intraoperative bleeding were positively correlated with stress parameters, including gamma waves and tension. For operators, surgeon experience was negatively correlated with concentration, tension, and SMR, gamma, M-beta, and H-beta waves (Pearson correlation, p<.05). However, for assistants, surgeon experience was positively correlated with concentration, tension, BPM, and SMR, M-beta, H-beta, and gamma waves. Bleeding amounts were correlated positively with gamma waves and tension for both operators and assistants (Pearson correlation, p<.05). Stress among operators was higher than that among assistants in terms of low frequency/high frequency ratio.

Conclusions: Operators and surgeons with low experience exhibited higher stress levels during surgery, which should be addressed when scheduling elective surgery to ensure optimal conditions among spine surgeons.
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1. College of Medicine (의과대학) > Dept. of Orthopedic Surgery (정형외과학교실) > 1. Journal Papers
Yonsei Authors
Kwon, Ji-Won(권지원) ORCID logo https://orcid.org/0000-0003-4880-5310
Moon, Seong Hwan(문성환)
Lee, Byung Ho(이병호) ORCID logo https://orcid.org/0000-0001-7235-4981
Lee, Hwan Mo(이환모) ORCID logo https://orcid.org/0000-0002-5405-3832
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