The influence of stress responses on surgical performance and outcomes: Literature review and the development of the surgical stress effects (SSE) framework

Kristin L. Chrouser, Jie Xu, Susan Hallbeck, Matthew B. Weinger, Melissa R. Partin

Research output: Contribution to journalReview articlepeer-review

11 Scopus citations

Abstract

Background: Surgical adverse events persist despite several decades of system-based quality improvement efforts, suggesting the need for alternative strategies. Qualitative studies suggest stress-induced negative intraoperative interpersonal dynamics might contribute to performance errors and undesirable patient outcomes. Understanding the impact of intraoperative stressors may be critical to reducing adverse events and improving outcomes. Data sources: We searched MEDLINE, psycINFO, EMBASE, Business Source Premier, and CINAHL databases (1996–2016) to assess the relationship between negative (emotional and behavioral) responses to acute intraoperative stressors and provider performance or patient surgical outcomes. Results/Conclusions: Drawing on theory and evidence from reviewed studies, we present the Surgical Stress Effects (SSE) framework. This illustrates how emotional and behavioral responses to stressors can influence individual surgical provider (e.g. surgeon, nurse) performance, team performance, and patient outcomes. It also demonstrates how uncompensated intraoperative threats and errors can lead to adverse events, highlighting evidence gaps for future research efforts.

Original languageEnglish (US)
Pages (from-to)573-584
Number of pages12
JournalAmerican journal of surgery
Volume216
Issue number3
DOIs
StatePublished - Sep 2018

Bibliographical note

Funding Information:
This work was supported by the Center for Veterans Research and Education (Chrouser) and the VA Health Services Research and Development Research Career Scientist Award #RCS 10-185 (Partin).

Funding Information:
This work was supported by the Center for Veterans Research and Education (Chrouser) and the VA Health Services Research and Development Research Career Scientist Award #RCS 10-185 (Partin).

Publisher Copyright:
© 2018

Keywords

  • Emotions
  • Operating room
  • Patient safety
  • Psychological
  • Stress
  • Surgeons

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