How do spine surgeons cope with psychological distress: results of a cross-sectional study

The psychological burden of major surgical complications in visceral surgery

BACKGROUND

Complications are common after major visceral surgery. Besides the patients, also surgeons may experience negative feelings by the patients suffering. Some studies have evaluated the mental burden caused by complications, mainly focusing on residents in different surgical specialties. No evidence exists on the mental burden of board-qualified visceral surgeons in Germany.

MATERIALS AND METHODS

A point prevalence study was conducted using an online questionnaire. For the inclusion of participants, all departments of visceral surgery at German university hospitals were addressed. The objective of the online questionnaire was to elaborate the perception of complications and the coping mechanisms used by the surgeons with the aim to characterize the mental burden and possible improvement strategies.

RESULTS

A total of 113 questionnaires were answered, 98 being complete. 73.2% of the participants were male, 46.9% were consultants and had a working experience of 11-20 years. Most common specialties were colorectal and general surgery and 91.7% claimed to have caused complications Clavien-Dindo grade IV or V. Subsequently, predominant feelings were anger, grief, self-doubt and guilt. The fear of being blamed by colleagues or to lose reputation were high. Especially female and younger surgeons showed those fears. Coping mechanisms used to overcome those negative feelings were interaction with friends and family (60.6%) or proactive training (59.6%). Only 17.2% of the institutions offered professional support. In institutions where no support was offered, 71.6% of the surgeons asked for support.

CONCLUSION

Surgical complications cause major psychological burden in surgeons in German university hospitals. Main coping mechanisms are communication with friends and families and professional education. Vulnerable subgroups, such as younger surgeons, may be at risk of suffering more from perceived mental distress. Nonetheless, the majority did not receive but asked for professional counselling. Thus, structured institutional support may ameliorate care for both surgeon and patient.

Ergonomics in Spine Surgery: A Systematic Review

STUDY DESIGN

This study is a systematic review.

OBJECTIVE

This systematic review aims to synthesize existing studies and highlight the significance of ergonomic considerations for spine surgeons' well-being and the impact on patient outcomes.

SUMMARY OF BACKGROUND DATA

Spine surgery is a physically demanding field that poses several risks to surgeons, particularly with musculoskeletal disorders. Despite the well-documented consequences of musculoskeletal injuries endured by surgeons, surgical ergonomics in spine surgery has received limited attention.

METHODS

Following PRISMA guidelines, a comprehensive literature search was conducted in PubMed and Embase. Studies focusing on surgeon ergonomics in spine surgery were selected. Data extracted included study details, surgeon demographics, ergonomic factors, and outcomes. Qualitative analysis was performed due to the heterogeneous nature of study designs and criteria.

RESULTS

Eleven studies met the inclusion criteria. Six studies utilized surveys to explore physical challenges, prevalence rates of pain, work practices, and ergonomic tools. Two studies employed optoelectronic motion analysis to assess the spinal angles of the surgeon during surgery. Two studies assesed ergonomics in different visualization methods using rapid entire body assessment (REBA). One study applied video analysis to scrutinize surgeons' neck postures during the case. The results demonstrated a varying prevalence and diverse presentations of musculoskeletal disorders, varying impact on surgical performance, and nuanced relationships between experience, workload, and ergonomic concerns.

CONCLUSION

This systematic review summarizes the heterogeneous evaluations of ergonomics in spine surgery. Overall, upwards of three-quarters of spine surgeons have reported musculoskeletal discomfort, most commonly presented as back pain, neck pain, and hand/wrist discomfort. These symptoms are often exacerbated by the use of loupes, operating bed height, and extended periods of time in various positions. Studies demonstrate that physical discomfort is associated with the surgeons' mental and emotional well-being, leading to stress, burnout, and reduced job satisfaction, all of which impact patient care.