eP634 - The Impact of Total Pelvic Exenteration on Surgeon Fatigue: Is It Time We Monitor Our Surgeons?

Purpose/Background: Total pelvic exenteration surgery (TPE) is a radical and complex procedure. Significant mental and physical stamina is required by surgeons performing TPE and despite this, the literature surrounding surgeon fatigue and performance is minimal. This feasibility study aimed to investigate the impact of performing high complexity TPE on surgeon fatigue.Methods/Interventions: Two surgeons ([1]/[2]) delivering high complexity TPEs in a high-volume tertiary centre (110/annum) were assessed using a predefined protocol: surgeon heart rate (posterior tibial pulse), concentration performance (Brickencamp d2 test of attention) and Surgery Task Load Index (SURG-TLX questionnaire) were measured across 3 intraoperative stages (mobilisation, dissection, and reconstruction) for all TPEs performed between 1st November 2022 – 1st September 2023. Both surgeons underwent baseline cardiopulmonary exercise testing.Results/Outcomes: 24 patients were included in the study. All-cause mortality rate was 0% at median follow up of 3 (1-11) months. Baseline VO2 max and anaerobic/lactate thresholds: #1 = 37.6 mL/kg/min (2.9086L/min), 50% and #2 = 54.3 mL/kg/min (4.7254L/min), 70% respectively. Watts and maximum HR at anaerobic thresholds: #1 = 154.2W, maximum HR = 115bpm and #2 = 305.8W, maximum HR = 146bpm). Mean error rate: d2 test number 1 and 2: #1 = 3.58% [0.91%–8.60%] [SD = 3.16, 95% CI = 0.27 to 6.91], #2 = 4.46% [1.37%–7.23%] [SD = 2.55, 95% CI = 1.79 to 7.14]. Mean error rate between d2 test 1 (8am) and test 2 (5pm) decreased in both #1 = -1.60% and #2 = −1.09%. A greater HR deviation from baseline correlated with a higher test 2 error rate for both subjects (p>0.05). During TPE dissection, mean HR for both #1 and #2 increased from baseline by a mean of 70% [1] and 51.9% [2] with a max HR of 106.7% [1] and 111.5% [2]. Both #1 and #2 demonstrated a smaller increase in mean HR from baseline during TPE dissection when operating together versus with residents (#1 = 46.7% [p < 0.001] and #2 = 48.1% [p>0.05]). Of the six domains (task complexity, situational stress, distractions and mental, physical, and temporal demands) tested within SURG-TLX, situational stress domain was most impacted.Conclusion/

Discussion: Both #1 and #2 heart rate fluctuations away from baseline corresponded with significant TPE intraoperative events. An assistant dependent change in HR was demonstrated by more extreme deviations from HR baseline. Despite increases in mean HR not correlating to a higher error rate in d2 test of attention, more extreme heart rate fluctuations away from baseline HR during TPE dissection period did correlate to increased average d2 error rate. Further investigation is required to optimise strategies minimising surgeon fatigue.