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Association of residents' neural signatures with stress resilience during surgery

Title: Association of residents' neural signatures with stress resilience during surgery
Authors: Modi, HN
Singh, H
Fiorentino, F
Orihuela-Espina, F
Athanasiou, T
Yang, G-Z
Darzi, A
Leff, DR
Item Type: Journal Article
Abstract: Importance: Intraoperative stressors may compound cognitive load, prompting performance decline and threatening patient safety. However, not all surgeons cope equally well with stress, and the disparity between performance stability and decline under high cognitive demand may be characterized by differences in activation within brain areas associated with attention and concentration such as the prefrontal cortex (PFC). Objective: To compare PFC activation between surgeons demonstrating stable performance under temporal stress with those exhibiting stress-related performance decline. Design, Setting, and Participants: Cohort study conducted from July 2015 to September 2016 at the Imperial College Healthcare National Health Service Trust, England. One hundred two surgical residents (postgraduate year 1 and greater) were invited to participate, of which 33 agreed to partake. Exposures: Participants performed a laparoscopic suturing task under 2 conditions: self-paced (SP; without time-per-knot restrictions), and time pressure (TP; 2-minute per knot time restriction). Main Outcomes and Measures: A composite deterioration score was computed based on between-condition differences in task performance metrics (task progression score [arbitrary units], error score [millimeters], leak volume [milliliters], and knot tensile strength [newtons]). Based on the composite score, quartiles were computed reflecting performance stability (quartile 1 [Q1]) and decline (quartile 4 [Q4]). Changes in PFC oxygenated hemoglobin concentration (HbO2) measured at 24 different locations using functional near-infrared spectroscopy were compared between Q1 and Q4. Secondary outcomes included subjective workload (Surgical Task Load Index) and heart rate. Results: Of the 33 participants, the median age was 33 years, the range was 29 to 56 years, and 27 were men (82%). The Q1 residents demonstrated task-induced increases in HbO2 across the bilateral ventrolateral PFC (VLPFC) and right dorsolateral PFC in the SP condition and in the VLPFC in the TP condition. In contrast, Q4 residents demonstrated decreases in HbO2 in both conditions. The magnitude of PFC activation (change in HbO2) was significantly greater in Q1 than Q4 across the bilateral VLPFC during both SP (mean [SD] left VLPFC: Q1, 0.44 [1.30] μM; Q4, -0.21 [2.05] μM; P < .001; right VLPFC: Q1, 0.46 [1.12] μM; Q4, -0.15 [2.14] μM; P < .001) and TP (mean [SD] left VLPFC: Q1, 0.44 [1.36] μM; Q4, -0.03 [1.83] μM; P = .001; right VLPFC: Q1, 0.49 [1.70] μM; Q4, -0.32 [2.00] μM; P < .001) conditions. There were no significant between-group differences in Surgical Task Load Index or heart rate in either condition. Conclusions and Relevance: Performance stability within TP is associated with sustained prefrontal activation indicative of preserved attention and concentration, whereas performance decline is associated with prefrontal deactivation that may represent task disengagement.
Issue Date: 7-Aug-2019
Date of Acceptance: 26-May-2019
URI: http://hdl.handle.net/10044/1/72476
DOI: 10.1001/jamasurg.2019.2552
ISSN: 2168-6254
Publisher: American Medical Association
Journal / Book Title: JAMA Surgery
Volume: 154
Issue: 10
Copyright Statement: © 2019 American Medical Association. All rights reserved.
Sponsor/Funder: National Institute of Health Research
National Institute for Health Research
Funder's Grant Number: NF SI 061710038
Keywords: Science & Technology
Life Sciences & Biomedicine
Surgery
PREFRONTAL CORTEX
OPERATING-ROOM
INDIVIDUAL-DIFFERENCES
NONTECHNICAL SKILLS
TECHNICAL SKILLS
TASK
PERFORMANCE
ACTIVATION
DISTRACTION
NIRS
Adaptation, Psychological
Adult
Cerebral Cortex
Cognition
Cohort Studies
Female
Heart Rate
Humans
Male
Middle Aged
Resilience, Psychological
Spectroscopy, Near-Infrared
Stress, Psychological
Surgical Procedures, Operative
Task Performance and Analysis
Workload
Workplace
Cerebral Cortex
Humans
Spectroscopy, Near-Infrared
Surgical Procedures, Operative
Cohort Studies
Adaptation, Psychological
Stress, Psychological
Cognition
Task Performance and Analysis
Heart Rate
Adult
Middle Aged
Workplace
Workload
Female
Male
Resilience, Psychological
Publication Status: Published
Conference Place: United States
Open Access location: https://pubmed.ncbi.nlm.nih.gov/31389994/
Article Number: ARTN e192552
Appears in Collections:Department of Surgery and Cancer
Faculty of Medicine
Institute of Global Health Innovation
Faculty of Engineering