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Overnight call is associated with poor resting heart rate and heart rate variability in orthopaedic surgeons
  1. Kyle R Sochacki1,
  2. David Dong1,
  3. Leif Peterson1,
  4. Patrick C McCulloch1,
  5. Kevin Lisman2,
  6. Joshua D Harris1
  1. 1 Houston Methodist Orthopedics and Sports Medicine, Houston, Texas, USA
  2. 2 Houston Cardiovascular Associates, Houston, Texas, USA
  1. Correspondence to Dr Joshua D Harris, Houston Methodist Orthopedics and Sports Medicine Houston Texas USA; joshuaharrismd{at}


Objectives The purpose of this study was to determine orthopaedic surgery residents’ and attending surgeons’ resting heart rate (RHR) and heart rate variability (HRV) and if there is a correlation between subject-specific variables (age, attending surgeon, resident, postgraduate year (PGY) level, gender, number of calls, total hours worked, and total hours of sleep) and surgeon RHR and HRV.

Methods Orthopaedic surgery residents and attending surgeons at a single institution were prospectively enrolled and provided a validated wearable device to determine hours of sleep, RHR and HRV. Demographic information, hours worked and overnight calls were recorded. Bivariate correlations were determined using the Spearman rank correlation. Multiple linear regression models were constructed to determine the effect of relevant variables. All p values were reported, and a significance level of α=0.05 was used (p<0.05).

Results Twenty-one of 26 enrolled subjects completed the 4-week study. The average RHR and HRV for orthopaedic surgeons was 61.8+10.0 bpm and 42.96+21.2ms, respectively. Residents had a significantly higher RHR (66.4+8.4 vs 55.6+8.9, p=0.011) compared with attending surgeons. Overnight calls had the strongest association with decreased HRV (r=−0.447; p=0.038), moderate positive correlation with RHR (r=0.593; p=0.005) and weak negative correlation with HRV (r=−0.469; p=0.032). There was no significant correlation between PGY level, gender, total hours worked and total hours of sleep with RHR or HRV.

Conclusion Orthopaedic surgeons have poor RHR and HRV. Additionally, the number of overnight calls had the strongest correlation with worse RHR and HRV.

Level of evidence Level II; diagnostic, individual cross-sectional study with a consistently applied reference standard.

  • heart rate
  • heart rate variability
  • orthopaedic surgeon
  • stress
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  • Contributors All the authors have been actively involved in the planning and enactment of the study and have also assisted with the preparation of the submitted article. KRS: drafted the manuscript and participated in the study design. DD: carried out the data analysis and study coordination. LEP: conducted the statistical analysis and revisions. KL, PCM and JDH: provided study design, coordination and manuscript revisions. The manuscript has been read and approved by all authors.

  • Funding Internally funded study by Houston Methodist Hospital.

  • Competing interests PCM has the following disclosures: speaker’s bureau/paid presentation by company/supplier (Vericel); research support from company/supplier (DePuy, A Johnson & Johnson Company; Arthrex): medical/orthopaedic publications editorial/governing board ( JDH has the following disclosures: AAOS: board or committee member; American Orthopaedic Society for Sports Medicine: board or committee member; Arthroscopy: editorial or governing board; Arthroscopy Association of North America: board or committee member; DePuy, A Johnson & Johnson Company: research support; Frontiers In Surgery: editorial or governing board; NIA Magellan: paid consultant; SLACK Incorporated: publishing royalties, financial or material support; Smith & Nephew: paid presenter or speaker, paid consultant, research support; Ossur: paid speaker.

  • Ethics approval Institutional Review Board (IRB) approval was obtained with assigned protocol number Pro0017663.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The datasets generated and/or analysed during the current study are not publicly available due to protected health information but are available from the corresponding author on reasonable request.

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