# A Systematic Review and Meta-Analysis of Heart Rate Variability in Assessing Surgeons’ Stress Levels

## TL;DR

This study reviews how heart rate variability can be used to measure stress in surgeons, highlighting the need for standardized methods across different ages and experience levels.

## Contribution

The paper systematically reviews HRV measures in surgeons and identifies gaps in standardizing stress assessment across age and experience.

## Key findings

- HRV measures like RMSSD and LF/HF ratio show potential for stress assessment in surgeons.
- Frequency-domain HRV measures exhibit more consistent patterns than time-domain features under stress.
- Current studies lack standardization and sufficient sample sizes to draw definitive conclusions.

## Abstract

Background: Surgeons’ stress can significantly impact performance, leading to medical errors. Various factors contribute to stress, including a procedure’s complexity and surgeon experience. However, the field currently lacks a standardised approach to measuring stress in surgeons of different ages and experience levels. Materials and Methods: This systematic review evaluated heart rate variability (HRV) measures used in surgery to assess stress, considering surgeon age and experience. We searched PubMed, Scopus, and Web of Science following PRISMA guidelines, focusing on studies reporting HRV measurements in surgeons during surgery and comparing different surgeries, procedures, or surgeon experiences. Results: Out of 1821 reviewed studies, nine papers met the criteria, which involved 74 subjects. These studies reported various HRV measures, including heart rate, RMSSD, SDNN, pNN50, LF/HF ratio, LF, and HF. Although all time-domain features tended to show a negative response to stress, frequency-domain measures exhibited consistent patterns. However, these findings should be considered preliminary due to the small number of papers, high heterogeneity among studies, and the fact that no study has established a standard for comparing HRV across different surgeon ages or experience levels. Conclusions: Finally, these findings call for future studies with robust designs to explore the use of HRV parameters for measuring stress over time while considering surgeon age and experience.