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

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)1203-1210
Number of pages8
JournalSpine Journal
Issue number8
Publication statusPublished - 2020 Aug

Bibliographical note

Funding Information:
The authors thank SOSO H&C (Jae-Yong Lee, Dongbin Min, Un-Hye Park, and Dae-sik Keum) for their technical support and analysis of the complex EEG and HRV data.

Publisher Copyright:
© 2020 Elsevier Inc.

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology


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