Influence of surgeon-related human factors on patient operative outcomesPerinatal mental health: how to improve midwives' training?
Supervisor :
Antoine DUCLOS
Stéphanie MAZZA
Summary of the thesis:
An estimated 20% of surgical patients develop complications, half of which are potentially avoidable. With nearly 7 million surgical patients presenting with major adverse events every year worldwide, 1 million of whom die during or immediately after surgery, the safety of surgical care is a major public health concern. Surgical care is a complex process, involving pre-operative care, anesthesia, surgical procedures and post-operative care, and depends on the patient's condition, as well as on the surgeon’s characteristics and the organizational context. Until now, the identification of risk factors for surgical complications has focused mainly on the characteristics of the patient and his or her care, with efforts to improve surgical outcomes in recent decades concentrating mainly on technical advances or standardization of procedures. Yet surgical outcome is only partly explained by these determinants. The surgeon's individual performance is a key factor in the success of surgery. This performance varies from one surgeon to another, and could fluctuate over time for the same surgeon, depending on intrinsic human parameters linked to his or her physical and mental condition, about which little is known today. These parameters have been studied in qualitative terms, but have rarely been quantified.
This thesis work will focus on the surgeon's individual human determinants, and will be part of the wider European TopSurgeons project (ERC Starting Grant), which aims to measure the influence of human and organizational factors on the surgeon's individual performance in improving patient outcomes, and to assess the impact of a personalized coaching program for surgeons on surgical outcomes. The project will be carried out in adult surgery departments at Hospices Civils de Lyon. A cohort of surgeons will be set up and followed over a one-year observation period, during which time a multitude of data will be collected on individual surgeon parameters (heart rate, sleep, physical activity) and patient surgical outcomes (morbi-mortality and operative time). Morbi-mortality will be assessed within 30 days of surgery, according to the Clavien-Dindo classification. The data will mainly come from Actigraph-POLAR sensors and the Hospices Civils de Lyon information system. The Actigraph sensors, used to collect data on sleep and physical activity, will be worn by surgeons 24 hours a day, 7 days a week for one year, while the POLAR sensors measuring heart rate will be worn only in the operating room for 4 weeks. Firstly, a literature review will be carried out to assess the current state of knowledge concerning the use of wearable sensors to measure surgeons' physiological parameters (sleep, stress and physical activity) in quantitative studies. Secondly, using data collected as part of the TopSurgeons project, we will assess the influence of surgeons’ sleep on surgical outcome. In an ancillary study, we will also explore the effect of surgeons' sleep and physical activity on their stress levels at the start of surgery.
If it provides tangible evidence of the influence of the surgeon's sleep on surgical outcome, this work could help to propose recommendations, tools and coaching programs for surgeons, enabling them to improve their sleep quality, and thus enhance the safety of patient care.
