外科医生压力与重大手术并发症之间的相关性

外科医生的压力可能影响技术和非技术技能，但对患者结局的后果仍未知。

To investigate whether surgeon physiological stress, as assessed by sympathovagal balance, is associated with postoperative complications.

研究外科医生生理应激（通过交感神经迷走神经平衡评估）是否与术后并发症相关。

This multicenter prospective cohort study included 14 surgical departments involving 7 specialties within 4 university hospitals in Lyon, France. Exclusion criteria consisted of patient age younger than 18 years, palliative surgery, incomplete operative time-stamping data, procedures with a duration of less than 20 minutes, and invalid surgeon heart rate variability (HRV) data. Data were accrued between November 1, 2020, and December 31, 2021, with 30-day follow-up completed on May 8, 2022. Analyses were performed from January 1 to May 31, 2024.

该多中心前瞻性队列研究包括14个外科科室，涉及法国里昂4所大学医院的7个专业。排除标准包括患者年龄小于18岁、姑息性手术、手术时间戳数据不完整、手术持续时间小于 20 min 和外科医生心率变异性 (HRV) 数据无效。数据收集于2020年11月01日至2021年12月31日，30天随访于2022年05月08日完成。分析时间为2024年01月01日至05月31日。

Sympathovagal balance of the attending surgeon in the first 5 minutes of surgery.

手术前 5 min 内主治医生的交感神经迷走神经平衡。

Major surgical complications, extended intensive care unit stay, and mortality within 30 days, after adjustment via mixed-effects multivariable logistic regression for surgeon age, professional status, the time of incision, the random effect of the surgeon, and a composite risk score incorporating patient comorbidities and surgery characteristics. Sympathovagal balance was quantified by the low frequency to high frequency (LF:HF) ratio derived from HRV data measured by chest monitors worn intraoperatively. The LF:HF ratio was normalized at the surgeon level to the median value observed for each surgeon during the study period to control for baseline differences.

主要手术并发症、延长重症监护病房住院时间和30天内死亡率，通过混合效应多变量逻辑回归校正外科医生年龄、专业状态、切口时间、外科医生的随机效应，以及结合患者合并症和手术特征的综合风险评分。交感神经迷走神经平衡通过术中佩戴的胸部监护仪测量的 HRV 数据得出的低频与高频 (LF：HF) 比值进行量化。LF:HF比在外科医生水平标准化为研究期间每名外科医生观察到的中位值，以控制基线差异。

A total of 793 surgical procedures performed by 38 attending surgeons were included in the analysis. Median patient age was 62 (IQR, 47-72) years, and 412 (52.0%) were female, with a median of 2 (IQR, 1-4) comorbidities. Median surgeon age was 46 (IQR, 39-52) years, 39 (78.9%) were male, and 22 (57.9%) were professors. Median surgeon heart rate was 88 (IQR, 77-99) beats per minute. Median surgeon LF:HF ratio was 7.16 (IQR, 4.52-10.72) before and 1.00 (IQR, 0.71-1.32) after normalization. Increased surgeon sympathovagal balance during the first 5 minutes of surgery was associated with significantly reduced major surgical complications (adjusted odds ratio [AOR], 0.63; 95% CI, 0.41-0.98; P = .04), though not with reduced intensive care unit stay (AOR, 0.34; 95% CI, 0.11-1.01; P = .05) or mortality (AOR, 0.18; 95% CI, 0.03-1.03; P = .05).

共有38名主治医生进行的793例外科手术被纳入分析。患者中位年龄为62岁 (IQR，47-72)，412例 (52.0%) 为女性，中位合并症为2例 (IQR，1-4)。外科医生的中位年龄为46岁 (IQR，39-52)，39名 (78.9%) 为男性，22名 (57.9%) 为教授。外科医生的中位心率为88(IQR，77-99) 次/分钟。标准化前，中位外科医生LF:HF比为7.16(IQR，4.52-10.72)，标准化后为1.00(IQR，0.71-1.32)。手术前 5 min 内外科医生交感神经迷走神经平衡的增加与重大手术并发症的显著减少相关（校正比值比 [AOR]，0.63；95%CI，0.41-0.98；P = .04），尽管重症监护室停留时间没有减少（AOR，0.34；95%CI，0.11-1.01；P = .05）或死亡率（AOR，0.18；95%CI，0.03-1.03；P = .05）.

Increased surgeon stress at the beginning of a procedure was associated with improved clinical patient outcomes. The results are illustrative of the complex relationship between physiological stress and performance, identify a novel association between measurable surgeon human factors and patient outcomes, and may highlight opportunities to improve patient care.

手术开始时外科医生压力增加与临床患者结局改善相关。结果说明了生理压力和性能之间的复杂关系，确定了可测量外科医生人为因素和患者结局之间的新相关性，并可能强调改善患者诊疗的机会。