Document Detail

Does orthopaedic surgical training induce hypertension? A pilot study.
MedLine Citation:
PMID:  22810159     Owner:  NLM     Status:  MEDLINE    
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.
Hari Om Gupta; Sanjay Gupta; Robert Lewis Carter; Aslam Mohammed; R M Dominic Meek
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Publication Detail:
Type:  Journal Article     Date:  2012-07-19
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  470     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-10-11     Completed Date:  2013-01-03     Revised Date:  2013-11-06    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3253-60     Citation Subset:  AIM; IM    
Touro College of Osteopathic Medicine, New York, NY, USA.
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MeSH Terms
Blood Pressure Determination
Education, Medical, Graduate
Heart Rate
Hypertension / etiology*
Orthopedic Procedures / adverse effects*
Orthopedics / education*
Physicians / psychology*
Pilot Projects
Stress, Psychological / etiology,  physiopathology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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