Does Orthopaedic Surgical Training Induce Hypertension? A Pilot Study

Abstract

Background Elevated blood pressure (BP) is associated with increased cardiovascular risks manifested by ischemic heart disease and stroke. Studies of cardiothoracic surgeons and neurosurgeons suggest surgery induces a hemodynamic stress malresponse. However, it is unclear whether these occur in orthopaedic surgeons. Questions/Purposes We measured the BP of surgeons during hallux valgus surgery, TKA, and THA with the: (1) trainee assisting the trainer, (2) the trainer assisting the trainee, (3) the trainee operating independently, and (4) compared the intraoperative changes in BP and heart rate of orthopaedic surgeons with those of a clinic day and during an exercise tolerance test.Methods We used an ambulatory BP monitor to measure the BP and heart rate of three consultants and their respective trainees during hallux valgus surgery, TKA, or THA. We noted if there were any differences in the stress response of the lead surgeon in comparison to when the same individual was assisting a trainee, and vice versa. Additionally, we recorded the trainee's BP and heart rate when they were operating independently. The intraoperative changes in BP and heart rate of orthopaedic surgeons were compared with those measured during a clinic day and during an exercise tolerance test. Results When the trainer was leading the operation, their mean arterial pressure gradually increased to 105 (range, 102-109) until implant placement. However, when the trainee was operating and the trainer assisting, the trainer's BP peaked (mean, 101; range, 95-111) at the beginning of the procedure and slowly declined as it progressed. The trainee's BP remained elevated throughout. The highest peaks for trainees were noted during independent operating. All of the surgeons had higher average BP readings (mean, 100; range, 95-108) and heart rate (mean, 86; range, 57-117) on days when they did surgery compared with baseline. Conclusions The elective operations studied induced a hypertensive response. The response was more marked in trainees than in trainers, particularly if the trainee was operating independently.

Is aneurysm surgery too exciting for our own good?

“…Even so, based on what we know from these two studies, aneurysm surgery does not seem to trigger extreme hemodynamic responses compared to other procedures or life situations. Similar hemodynamic responses have for example been seen during hallux valgus surgery, but with larger responses in trainees than in trainers [5]. Also in healthy men watching (Scottish!)…”

Personal Health of Spine Surgeons Can Impact Perceptions, Decision-Making and Healthcare Delivery During the COVID-19 Pandemic - A Worldwide Study

“…Furthermore, orthopedic surgical training can induce hypertension, though transient in nature. 19 Similarly, neurosurgery has been demonstrated to increase intraoperative blood pressure to levels higher than vigorous exercise. 20 Regardless, respondents with 1 comorbidity varied in their opinions regarding standard precautions and a lack of association between number of comorbidities and use of additional PPE during surgery infers riskier behavior by surgeons who would otherwise benefit from heightened awareness of their health.…”

The Lion Heart of a Neurosurgeon: the Stress during a Life of Neurosurgery

“…Studies have shown that all these pathophysiological changes that occur in prolonged stress may lead to anxiety, depression, alcoholism, substance abuse, broken relationships or even suicide, all of which are more common among surgeons and physicians than in other professions [9]. Also, with regard to surgical professions, studies have shown that the constant intraoperative fluctuation of BP and HR may increase the risk for coronary events [23], cerebrovascular disease [22], diabetes (35) and impairment of cognitive functioning and structural brain changes [18,38] or depression [47]. A recent study in orthopedic surgeons has shown that the BP of trainees was much higher when they performed surgery alone than when they performed it under supervision [18].…”

“…As concerns the high levels of stress during surgery, studies have shown that they are specific, higher in surgical residents and young specialists, and are attributed to the novelty of the procedures [18], and on the other hand, experienced surgeons are accustomed to the stress of surgery under pressure and intraoperative complications [12,13].…”

“…The surgeon's cardiovascular response to surgical procedures undoubtedly varies during the surgical procedures, being higher in more difficult surgical procedures or in the critical phases of the surgery [18,46]. Thus, Sharma et al reported higher incidence of abnormal BP elevation episodes during vestibular schwannoma excision and aneurysm clipping surgeries, compared to the rest of neurosurgical procedures on the brain [45].…”