Measuring and reducing surgical staff stress in a realistic operating room setting using EDA monitoring and smart hearing protection

Background – Stress is a critical factor in the operating room (OR) and affects both the performance and well-being of surgical staff. Measuring and mitigating this stress can therefore improve patient safety and healthcare worker health. Objective – This study aimed to evaluate the stress levels of OR staff in a simulated surgical setting using electrodermal activity (EDA) and to assess the potential of smart hearing protection systems for stress reduction. Methods – Twenty-nine participants performed a standardized laparoscopic task in a simulated surgical setting using the LapSim® under three auditory conditions: silence, typical operating room noise (excluding alarm and speech signals), and operating room noise with simulated smart hearing protection. The smart hearing protection was simulated offline to generate an adjusted operating room soundscape rather than being implemented in real time. The smart hearing protection technology incorporates two distinct algorithms: one for speech enhancement based on blind source separation and another that reconstructs the optimal acoustic conditions for the surgical environment. Subjective workload was assessed using the Surgery Task Load Index (SURG-TLX) questionnaire, while physiological stress was measured using electrodermal activity (EDA). Cross-correlation was used to explore relationships between subjective and physiological stress measures. Results – Subjective stress levels were higher under typical operating room noise conditions (mean SURG-TLX score: 52) and markedly lower when using hearing protection with speech-filtering algorithms (mean SURG-TLX score for blind source separation: 43; mean score for the optimal condition: 42). Physiological stress, as measured by EDA, showed a reduction when smart hearing protection was used, although differences were not statistically significant. No significant correlation was found between SURG-TLX scores and EDA. Conclusion – Smart hearing protection may help reduce perceived and physiological stress during surgical procedures. The lack of correlation between subjective and physiological data highlights the importance of a multimodal approach in stress research.