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Wong SW, Parkes A, Crowe P. Ergonomic interventions to reduce upper limb musculoskeletal pain during robotic surgery: a narrative review. J Robot Surg 2024; 18:224. [PMID: 38801617 PMCID: PMC11130008 DOI: 10.1007/s11701-024-01992-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024]
Abstract
There is a high prevalence of upper limb musculoskeletal pain among robotic surgeons. Poor upper limb ergonomic positioning during robotic surgery occurs when the shoulders are abducted, and the elbows are lifted off the console armrest. The validated rapid upper limb assessment can quantify ergonomic efficacy. Surface electromyography and hand dynamometer assessment of strength are the most common methods to assess muscle fatigue. A literature review was performed to find evidence of ergonomic interventions which reduce upper limb musculoskeletal pain during robotic surgery. There is a paucity of studies which have reported on this topic. In other occupations, there is strong evidence for the use of resistance training to prevent upper extremity pain. Use of forearm compression sleeves, stretching, and massage may help reduce forearm fatigue. Microbreaks with targeted stretching, active ergonomic training, improved use of armrest, and optimal hand controller design have been shown to reduce upper limb musculoskeletal pain. Future studies should assess which interventions are beneficial in reducing surgeon upper limb pain during robotic surgery.
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Affiliation(s)
- Shing Wai Wong
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia.
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia.
| | - Allan Parkes
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia
| | - Philip Crowe
- Randwick Campus, School of Clinical Medicine, The University of New South Wales, Sydney, NSW, Australia
- Department of General Surgery, Prince of Wales Hospital, Sydney, NSW, Australia
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2
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Tarabishy S, Brown G, Hudson HT, Herrera FA. Fixing Hands, Breaking Backs: The Ergonomics and Physical Detriment of the Hand Surgeon. Hand (N Y) 2024; 19:509-515. [PMID: 36278421 PMCID: PMC11067836 DOI: 10.1177/15589447221126765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
BACKGROUND Work-related musculoskeletal disorders in surgeons have been well documented. Hand surgeons, however, represent a unique population of surgical subspecialists due to frequent use of operative magnification. Thus, we aim to examine the contributing factors, types, and frequencies of work-related musculoskeletal injuries experienced by hand surgeons. METHODS A Research Electronic Data Capture survey including 12 demographic and 13 Nordic Musculoskeletal Injury Questionnaire questions was emailed twice to all active members of the American Association for Hand Surgery (AAHS). Data collection remained open for 30 days. RESULTS Ninety-six of 1228 AAHS members (8%) responded. Respondents were predominantly attendings (88, 91.7%), male (67, 69.8%), in academic practice (48, 50%), and in the age range of 35 to 44 years (34, 35.4%). Sixty-nine respondents (71.9%) attribute discomfort to their profession. Pain (56, 82.4%) and stiffness (46, 67.6%) were the most frequent symptoms, most common in the neck and wrist/hand regions. Fifty-nine (61.5%) respondents had acute (<1 week) discomfort, with onset most frequently reported after surgery (45, 48.9%). Thirty-two (34.8%) of the respondents state they worry these symptoms will hinder their ability to perform surgery in future. Sixteen (16.7%) respondents sustained a musculoskeletal injury directly related to work. Exercise was the most popular nonmedical therapy, while over-the-counter medications were the most popular medical therapy. CONCLUSION The unique ergonomics of hand surgery, including frequent use of loupes and microscopes, appear detrimental to the surgeons' health and career longevity. Further research will allow for the development of preventative measures, with the goal of facilitating longer, more productive careers for hand surgeons.
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Affiliation(s)
| | | | | | - Fernando A. Herrera
- Medical University of South Carolina, Charleston, USA
- Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SC, USA
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3
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Syros A, Yakkanti RR, Sedani AB, Swonger RM, Hernandez VH. Prevalence of disability secondary to work-related musculoskeletal injuries among orthopaedic surgeons. J Clin Orthop Trauma 2024; 51:102402. [PMID: 38751749 PMCID: PMC11092878 DOI: 10.1016/j.jcot.2024.102402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 04/08/2024] [Indexed: 05/18/2024] Open
Abstract
Background Orthopaedic surgeons encounter many work-place hazards that can lead to musculoskeletal injuries (MSI) and their clinical sequelae. This study aims to evaluate musculoskeletal injuries among orthopaedic surgeons and compare their rates of disability claims and time off work. Additionally, this study provides a perspective on the financial impact of work-related injuries among orthopaedic surgeons. Methods An electronic survey was developed to assess work-place hazards among orthopaedic surgeons. The survey included questions on demographics, musculoskeletal injuries, and disabilities. Electronic surveys were emailed to all current members of the American Academy of Orthopaedic Surgeons (AAOS) between March and April 2021 in the United States. Descriptive statistics were run for all variables and chi-squared and t-tests when applicable. Results 1645 members of the AAOS completed the survey (7.03 % response rate), and 243 (14.9 %) reported a work-related injury to their place of employment at some point during their career. Of the respondents, 1129 (76.4 %) reported having active disability insurance, and 61 (3.7 %) orthopaedic surgeons filed a disability claim secondary to a work-related injury at some point during their career. Of the surgeons that claimed disability, 39 (66.1 %) returned to work, and 20 (33.9 %) had an early retirement. Foot/ankle injuries led to the highest rates of early retirement overall (62.5 %). Conclusion This study captures the prevalence of disability claims made by orthopaedic surgeons due to work-place hazards. To our knowledge, this is the first study to broadly compare disability claims amongst orthopaedic surgeons. This data should be used to implement changes in the orthopaedic community to decrease injuries and disability claims.
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Affiliation(s)
- Alina Syros
- University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | | | - Anil B. Sedani
- University of Miami Department of Orthopaedic Surgery, Miami, FL, 33136, USA
| | - Ronald M. Swonger
- University of Miami Miller School of Medicine, Miami, FL, 33136, USA
| | - Victor H. Hernandez
- University of Miami Department of Orthopaedic Surgery, Miami, FL, 33136, USA
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Asiri FA, Alqhtani AA, Assiri AH, Alqahtani MH, Motlag DS, Tedla JS, Alwadai SA. Shoulder Pain and Disability Scores and the Factors Influencing Them among Orthopedic Surgeons Working in the Kingdom of Saudi Arabia: A Cross-Sectional Study. J Pers Med 2023; 14:55. [PMID: 38248756 PMCID: PMC10820873 DOI: 10.3390/jpm14010055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 12/16/2023] [Accepted: 12/25/2023] [Indexed: 01/23/2024] Open
Abstract
(1) Background: Musculoskeletal pain is common among orthopedic surgeons. Their common musculoskeletal issues include shoulder pain and disability. Many associated factors could lead to this pain and disability; by identifying these, we can prevent orthopedic surgeons' pain and improve their functional capacity. (2) Methods: This study aimed to gather quantitative data regarding the shoulder pain and disability experienced by orthopedic surgeons. It also aimed to explore the potential correlations between demographic characteristics and work-related factors and their pain and disability. This study interviewed 150 orthopedic surgeons working in the Kingdom of Saudi Arabia, asking questions on the Shoulder Pain and Disability Index (SPADI) scale and about their demographic characteristics. (3) Results: All interviewed orthopedic surgeons were male, married, and nonsmokers. Their SPADI pain subsection score was 25.24%, their SPADI disability subsection score was 21.25%, and their total SPADI score was 22.79%. Among the examined demographic characteristics, total SPADI scores have a significant positive correlation with body weight (Spearman's ρ = 0.432; p < 0.05) and body mass index (BMI; ρ = 0.349; p < 0.05). (4) Conclusions: Our findings indicate that all orthopedic surgeons generally suffer from moderate shoulder pain and disability. Body weight and body mass index are important factors that may influence shoulder pain and disability among orthopedic surgeons.
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Affiliation(s)
- Faya Ali Asiri
- Department of Orthopedics, Ahad Rufaidah General Hospital, Abha 62242, Saudi Arabia;
| | - Abdulrhman Abdullh Alqhtani
- Department of Orthopedics, Aseer Central Hospital, Abha 62523, Saudi Arabia; (A.A.A.); (A.H.A.); (M.H.A.); (D.S.M.); (S.A.A.)
| | - Abdullah Hassan Assiri
- Department of Orthopedics, Aseer Central Hospital, Abha 62523, Saudi Arabia; (A.A.A.); (A.H.A.); (M.H.A.); (D.S.M.); (S.A.A.)
| | - Mohammed Hassan Alqahtani
- Department of Orthopedics, Aseer Central Hospital, Abha 62523, Saudi Arabia; (A.A.A.); (A.H.A.); (M.H.A.); (D.S.M.); (S.A.A.)
| | - Dhuha Saeed Motlag
- Department of Orthopedics, Aseer Central Hospital, Abha 62523, Saudi Arabia; (A.A.A.); (A.H.A.); (M.H.A.); (D.S.M.); (S.A.A.)
| | - Jaya Shanker Tedla
- Department of Medical Rehabilitation Science, College of Applied Medical Sciences, King Khalid University, Abha 62421, Saudi Arabia
| | - Saad Ali Alwadai
- Department of Orthopedics, Aseer Central Hospital, Abha 62523, Saudi Arabia; (A.A.A.); (A.H.A.); (M.H.A.); (D.S.M.); (S.A.A.)
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Ünver S, Makal Orğan E. The effect of anti-fatigue floor mat on pain and fatigue levels of surgical team members: A crossover study. APPLIED ERGONOMICS 2023; 110:104017. [PMID: 36933417 DOI: 10.1016/j.apergo.2023.104017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/09/2023] [Accepted: 03/13/2023] [Indexed: 06/18/2023]
Abstract
As ergonomics is important to maintain comfort, this study aimed to examine the effect of anti-fatigue floor mats on pain and fatigue levels of surgical team members. Thirty-eight members participated in this crossover-designed study with no-mat and with-mat conditions, separated by a one-week washout period. They stood on the 15 mm thick rubber anti-fatigue floor mat and on the standard antistatic polyvinyl chloride flooring surface during the surgical procedures. Subjective ratings of pain and fatigue levels were measured pre and after-surgery for each experimental condition using the Visual Analogue Scale and Fatigue-Visual Analogue Scale scales. The after-surgery pain and fatigue levels for the with-mat condition were significantly lower than the no mat condition (p < .05). Consequently, anti-fatigue floor mats are effective in decreasing pain and fatigue levels of surgical team members during surgical procedures. Using anti-fatigue mats may be a practical and easy way to prevent discomfort that is often experienced by surgical teams.
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Affiliation(s)
- Seher Ünver
- Trakya University, Faculty of Health Sciences, Department of Surgical Nursing, Edirne, Turkey.
| | - Esra Makal Orğan
- Trakya University, Faculty of Health Sciences, Department of Surgical Nursing, Edirne, Turkey.
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6
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Lewis TL, Alkhalfan Y, Ferreira GF, Nunes GA, Lam P, Ray R. Optimizing the Operating Room Setup for Minimally Invasive Forefoot Surgery: Technical Tip. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231198235. [PMID: 37720565 PMCID: PMC10503294 DOI: 10.1177/24730114231198235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Affiliation(s)
- Thomas L. Lewis
- King’s Foot and Ankle Unit, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Yousif Alkhalfan
- Guy’s and St Thomas’ NHS Foundation Trust, Maze Pond, London, United Kingdom
| | - Gabriel Ferraz Ferreira
- Foot and Ankle Surgery Group, Orthopaedics and Traumatology Unit, Prevent Senior, São Paulo, Brazil
| | | | - Peter Lam
- Orthopaedic and Arthritis Specialist Centre, Chatswood, Sydney, Australia
| | - Robbie Ray
- King’s Foot and Ankle Unit, King’s College Hospital NHS Foundation Trust, London, United Kingdom
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Schupper AJ, Hrabarchuk EI, McCarthy L, Hadjipanayis CG. Improving Surgeon Well-Being: Ergonomics in Neurosurgery. World Neurosurg 2023; 175:e1220-e1225. [PMID: 37427701 DOI: 10.1016/j.wneu.2023.04.102] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/24/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Musculoskeletal disorders are common among surgeons, and affect most neurosurgeons over the course of their career. Although all subspecialist neurosurgeons may be affected by physical strain, spine surgeons and skull base surgeons have a high propensity for workplace injury as a result of long procedures with repetitive movements in strained physical positions. METHODS In this review, the prevalence of musculoskeletal disorders in neurosurgery, the state of innovation to improve ergonomics in the operating room for neurosurgeons, and potential limitations in advancing technology with the goal of maximizing neurosurgeon longevity are discussed. RESULTS Innovations such as robotics, the exoscope, and handheld devices with more degrees of freedom have allowed surgeons to maneuver instruments without exerting excessive effort, all while maintaining neutral body positioning, avoiding joint and muscle strain. CONCLUSIONS As new technology and innovation in the operating room develop, there has been a larger emphasis placed on maximizing surgeon comfort and neutral positioning, by minimizing force exertion and fatigue.
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Affiliation(s)
- Alexander J Schupper
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Eugene I Hrabarchuk
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Lily McCarthy
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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8
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Farnworth AL, Bugby SL. Intraoperative Gamma Cameras: A Review of Development in the Last Decade and Future Outlook. J Imaging 2023; 9:jimaging9050102. [PMID: 37233321 DOI: 10.3390/jimaging9050102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/05/2023] [Accepted: 05/08/2023] [Indexed: 05/27/2023] Open
Abstract
Portable gamma cameras suitable for intraoperative imaging are in active development and testing. These cameras utilise a range of collimation, detection, and readout architectures, each of which can have significant and interacting impacts on the performance of the system as a whole. In this review, we provide an analysis of intraoperative gamma camera development over the past decade. The designs and performance of 17 imaging systems are compared in depth. We discuss where recent technological developments have had the greatest impact, identify emerging technological and scientific requirements, and predict future research directions. This is a comprehensive review of the current and emerging state-of-the-art as more devices enter clinical practice.
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Affiliation(s)
- Andrew L Farnworth
- Department of Physics, Loughborough University, Loughborough LE11 3TU, UK
| | - Sarah L Bugby
- Department of Physics, Loughborough University, Loughborough LE11 3TU, UK
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9
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Barrios EL, Polcz VE, Hensley SE, Sarosi GA, Mohr AM, Loftus TJ, Upchurch GR, Sumfest JM, Efron PA, Dunleavy K, Bible L, Terracina KP, Al-Mansour MR, Gravina N. A narrative review of ergonomic problems, principles, and potential solutions in surgical operations. Surgery 2023:S0039-6060(23)00177-0. [PMID: 37202309 DOI: 10.1016/j.surg.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 04/03/2023] [Accepted: 04/05/2023] [Indexed: 05/20/2023]
Abstract
BACKGROUND Ergonomic development and awareness are critical to the long-term health and well-being of surgeons. Work-related musculoskeletal disorders affect an overwhelming majority of surgeons, and various operative modalities (open, laparoscopic, and robotic surgery) differentially affect the musculoskeletal system. Previous reviews have addressed various aspects of surgical ergonomic history or methods of ergonomic assessment, but the purpose of this study is to synthesize ergonomic analysis by surgical modality while discussing future directions of the field based on current perioperative interventions. METHODS pubmed was queried for "ergonomics," "work-related musculoskeletal disorders," and "surgery," which returned 124 results. From the 122 English-language papers, a further search was conducted via the articles' sources for relevant literature. RESULTS Ninety-nine sources were ultimately included. Work-related musculoskeletal disorders culminate in detrimental effects ranging from chronic pain and paresthesias to reduced operative time and consideration for early retirement. Underreporting symptoms and a lack of awareness of proper ergonomic principles substantially hinder the widespread utilization of ergonomic techniques in the operating room, reducing the quality of life and career longevity. Therapeutic interventions exist at some institutions but require further research and development for necessary widespread implementation. CONCLUSION Awareness of proper ergonomic principles and the detrimental effects of musculoskeletal disorders is the first step in protecting against this universal problem. Implementing ergonomic practices in the operating room is at a crossroads, and incorporating these principles into everyday life must be a priority for all surgeons.
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Affiliation(s)
- Evan L Barrios
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Valerie E Polcz
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Sara E Hensley
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - George A Sarosi
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Alicia M Mohr
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Tyler J Loftus
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Gilbert R Upchurch
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Jill M Sumfest
- Gatorcare Health Management Corporation, University of Florida, Gainesville, FL
| | - Philip A Efron
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Kim Dunleavy
- Department of Physical Therapy, University of Florida, Gainesville, FL
| | - Letitia Bible
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Krista P Terracina
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Mazen R Al-Mansour
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL
| | - Nicole Gravina
- Department of Psychology, University of Florida, Gainesville, FL.
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Byrne JE, Rodriguez-Patarroyo FA, Mascha EJ, Han Y, Bravo M, Bloomfield MR, Rao SM, Sessler DI. Cooling vest improves surgeons' thermal comfort without affecting cognitive performance: a randomised cross-over trial. Occup Environ Med 2023; 80:339-345. [PMID: 37142418 DOI: 10.1136/oemed-2022-108457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 01/19/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Surgeons become uncomfortable while performing surgery because heat transfer and evaporative cooling are restricted by insulating surgical gowns. Consequently, perceptions of thermal discomfort during surgery may impair cognitive performance. We, therefore, aimed to evaluate surgeons' thermal comfort, cognitive performance, core and mean skin temperatures, perceptions of sweat-soaked clothing, fatigue and exertion with and without a CoolSource cooling vest (Cardinal Health, Dublin, Ohio, USA). METHODS Thirty orthopaedic surgeons participated in a randomised cross-over trial, each performing four total-joint arthroplasties with randomisation to one of four treatment sequences. The effects of cooling versus no cooling were measured using a repeated-measures linear model accounting for within-subject correlations. RESULTS The cooling vest improved thermal comfort by a mean (95% CI) of -2.1 (-2.7 to -1.6) points on a 0-10 scale, p<0.001, with no evidence of treatment-by-period interaction (p=0.94). In contrast, cooling had no perceptible effect on cognition, with an estimated mean difference (95% CI) in Cleveland Clinic Cognitive Battery (C3B) Processing Speed Test score of 0.03 (95% CI -2.44 to 2.51), p=0.98, or in C3B Visual Memory Test score with difference of 0.88 (95% CI -2.25 to 4.01), p=0.57. Core temperature was not lower with the cooling vest, with mean difference (95% CI) of -0.13 (-0.33°C to 0.07°C), p=0.19, while mean skin temperature was lower, with mean difference of -0.23 (95% CI -0.40°C to -0.06°C) lower, p=0.011. The cooling vest significantly reduced surgeons' perceptions of sweat-soaked clothing, fatigue and exertion. CONCLUSIONS A cooling vest worn during surgery lowered core and skin temperatures, improved thermal comfort, and decreased perceptions of sweating and fatigue, but did not improve cognition. Thermal discomfort during major orthopaedic surgery is thus largely preventable, but cooling does not affect cognition. TRIAL REGISTRATION NUMBER NCT04511208.
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Affiliation(s)
- Jill E Byrne
- Case Western Reserve University, Cleveland, Ohio, USA
| | | | - Edward J Mascha
- Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Yanyan Han
- Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
- Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mauro Bravo
- Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
| | | | - Stephen M Rao
- Outcomes Research, Cleveland Clinic, Cleveland, Ohio, USA
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Luger T, Bonsch R, Seibt R, Krämer B, Rieger MA, Steinhilber B. Intraoperative active and passive breaks during minimally invasive surgery influence upper extremity physical strain and physical stress response-A controlled, randomized cross-over, laboratory trial. Surg Endosc 2023:10.1007/s00464-023-10042-9. [PMID: 37084097 PMCID: PMC10120511 DOI: 10.1007/s00464-023-10042-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/25/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE Investigate the effect of passive, active or no intra-operative work breaks on static, median and peak muscular activity, muscular fatigue, upper body postures, heart rate, and heart rate variability. BACKGROUND Although laparoscopic surgery is preferred over open surgery for the benefit of the patient, it puts the surgeons at higher risk for developing musculoskeletal disorders especially due to the less dynamic and awkward working posture. The organizational intervention intraoperative work break is a workplace strategy that has previously demonstrated positive effects in small-scale intervention studies. METHODS Twenty-one surgeons were exposed to three 90-min conditions: no breaks, 2.5-min passive (standing rest) or active (targeted stretching and mobilization exercises) breaks after 30-min work blocks. Muscular activity and fatigue of back, shoulder and forearm muscles were assessed by surface electromyography; upper body posture, i.e., spinal curvature, by inclination sensors; and heart rate and variability (HRV) by electrocardiography. Generalized estimating equations were used for statistical analyses. This study (NCT03715816) was conducted from March 2019 to October 2020. RESULTS The HRV-metric SDNN tended to be higher, but not statistically significantly, in the intervention conditions compared to the control condition. No statistically significant effects of both interventions were detected for muscular activity, joint angles or heart rate. CONCLUSION Intraoperative work breaks, whether passive or active, may counteract shoulder muscular fatigue and increase heart rate variability. This tendency may play a role in a reduced risk for developing work-related musculoskeletal disorders and acute physical stress responses.
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Affiliation(s)
- Tessy Luger
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany.
| | - Rosina Bonsch
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany
- Plastic, Reconstructive and Burn Surgery, Clinic for Hand, BG Clinic Tübingen, Schnarrenbergstraße 95, 72076, Tübingen, Germany
| | - Robert Seibt
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany
| | - Bernhard Krämer
- Department of Gynecology and Obstetrics, University Hospital Tübingen, Calwerstraße 7, 72076, Tübingen, Germany
| | - Monika A Rieger
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany
| | - Benjamin Steinhilber
- Institute of Occupational and Social Medicine and Health Services Research, Eberhard Karls University and University Hospital Tübingen, Wilhelmstraße 27, 72074, Tübingen, Germany
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12
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Yakkanti RR, Sedani AB, Syros A, Aiyer AA, D’Apuzzo MR, Hernandez VH. Prevalence and Spectrum of Occupational Injury Among Orthopaedic Surgeons: A Cross-Sectional Study. JB JS Open Access 2023; 8:JBJSOA-D-22-00083. [PMID: 36733707 PMCID: PMC9886518 DOI: 10.2106/jbjs.oa.22.00083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Orthopaedic surgeons are at increased risk for many occupational hazards, both physical and mental. The aim of this study was to evaluate a wide range of work-related injuries among orthopaedic surgeons in the United States. Methods An electronic survey was developed to assess both physical and mental occupational hazards among orthopaedic surgeons. Descriptive statistics were analyzed for all survey items and compared using chi-square and paired t tests, as appropriate. Results The 1,645 responding orthopaedic surgeons (7% response rate) reported a total of 2,702 work-related musculoskeletal injuries, 17.9% of which required surgical treatment. Of the 61 who filed a disability claim, only 66% returned to work and 34% retired early. Additionally, 17.4% of respondents reported having been diagnosed with cancer since starting practice, and 93.8% reported experiencing a finger stick at some point in their career. Over one-half (55.8%) had experienced feelings of psychological distress since beginning practice, and nearly two-thirds (64.4%) reported burnout from work. Conclusions This study captured a spectrum of occupational injuries that pose longitudinal risks to an orthopaedic surgeon's physical and mental well-being. Our hope is that this analysis of occupational hazards will help to raise awareness among the orthopaedic and medical communities and lead to efforts to reduce these risks. Level of Evidence Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ramakanth R. Yakkanti
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida
| | - Anil B. Sedani
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida
| | - Alina Syros
- Miller School of Medicine, University of Miami, Miami, Florida,Email for corresponding author:
| | - Amiethab A. Aiyer
- Department of Orthopaedic Surgery, Johns Hopkins Medicine, Baltimore, Maryland
| | - Michele R. D’Apuzzo
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida
| | - Victor H. Hernandez
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida
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13
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Xu AL, Covarrubias OG, Yakkanti RR, Sotsky RB, Aiyer AA. The Biomechanical Burden of Orthopaedic Procedures and Musculoskeletal Injuries Sustained by Orthopaedic Surgeons: A Systematic Review. JBJS Rev 2023; 11:01874474-202301000-00010. [PMID: 36722828 DOI: 10.2106/jbjs.rvw.22.00202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Orthopaedic surgeons are at high risk for experiencing work-related musculoskeletal (MSK) injuries and chronic pain due to repetitive large magnitude forces, altered posture from lead vests, and prolonged irregular body positions. We sought to synthesize available evidence regarding (1) the biomechanics of orthopaedic surgery and (2) MSK injuries sustained by orthopaedic surgeons with subsequent treatment and consequences. METHODS To conduct this systematic review, we queried 4 databases (PubMed, Embase, MEDLINE, and Web of Science) for original research studies presenting on the biomechanics of orthopaedic surgery or MSK injuries sustained by orthopaedic surgeons. Studies were excluded if they were not original research (i.e., reviews) or reported on non-MSK injuries and injuries in patients or nonorthopaedic specialists. The literature search yielded 3,202 publications, 34 of which were included in the final analysis. RESULTS Eight studies reported on the biomechanics of orthopaedic surgery. Surgeons spent an average 41.6% of operating time slouched. Head and whole spine angles were closest to natural standing position when using a microscope for visualization and with higher surgical field heights. Use of lead aprons resulted in a shifted weight distribution on the forefoot, gain in thoracic kyphosis, and increase in lateral deviation from postural loading. Twenty-six studies reported on MSK symptoms and injuries experienced by orthopaedic surgeons, with an overall prevalence from 44% to 97%. The most common body regions involved were lower back (15.2%-89.5%), hip/thigh (5.0%-86.6%), neck (2.4%-74%), hand/wrist (10.5%-54%), shoulder (7.1%-48.5%), elbow (3.1%-28.3%), knee/lower leg (7.9%-27.4%), and foot/ankle (7%-25.7%). Of surgeons with any reported MSK symptom or injury, 27% to 65.7% required nonoperative treatment, 3.2% to 34.3% surgery, and 4.5% to 31% time off work. Up to 59.3% of surgeons reported that their injuries would negatively influence their ability to perform surgical procedures in the future. CONCLUSIONS The orthopaedic surgeon population experiences a high prevalence of MSK symptoms and injuries, likely secondary to the biomechanical burdens of tasks required of them during strenuous operations. LEVEL OF EVIDENCE Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Amy L Xu
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Oscar G Covarrubias
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ramakanth R Yakkanti
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, Florida
| | - Rachel B Sotsky
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Amiethab A Aiyer
- Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
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14
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Cohen-Rosenblum AR, Varady NH, Leonovicz O, Chen AF. Repetitive Musculoskeletal Injuries: A Survey of Female Adult Reconstruction Surgeons. J Arthroplasty 2022; 37:1474-1477.e6. [PMID: 35026370 DOI: 10.1016/j.arth.2022.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 12/30/2021] [Accepted: 01/03/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Occupational injuries are a prevalent and costly problem for orthopedic surgeons, especially arthroplasty surgeons performing physically demanding and repetitive tasks. The purpose of this study was to characterize occupational musculoskeletal injuries in female adult reconstruction surgeons. METHODS A prospective survey about workplace musculoskeletal injuries was distributed to female attending adult reconstruction surgeons in May 2020. Participants were identified using subspecialty membership data, social media, and personal contacts. Results were analyzed using descriptive statistics. RESULTS Of the total 63 female arthroplasty surgeons who responded, 65.1% were 30-45 year old, and 42.9% were within 5 years of practice, 68.3% sustained an occupational musculoskeletal injury, most commonly forearm/wrist/hand (79.1%), shoulder (48.8%), and low back (44.2%); 10.0% of reported occupational injuries not related to pregnancy resulted in the surgeon requiring time off work, while 48.2% required temporary modifications of job performance, and 10.9% required surgical treatment. Of the injured surgeons who reported having been pregnant, 65.4% reported a workplace exacerbation of a pregnancy-related musculoskeletal condition, including low back pain (52.9%), pubic symphysis pain (35.3%), and carpal tunnel syndrome (29.4%). CONCLUSION A total of 68.3% of female arthroplasty surgeons reported occupational musculoskeletal injuries, predominately forearm/wrist/hand, with a portion of those requiring modifications of job performance. Musculoskeletal injuries may be mitigated by performing repetitive tasks ergonomically, correcting posture, using appropriately sized instrumentation, and using automated or lighter instruments, to potentially avoid modifications to job performance, time off work, or even surgical procedures. Further studies should investigate factors that contribute to injuries in arthroplasty surgeons and how they can be prevented.
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Affiliation(s)
- Anna R Cohen-Rosenblum
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Nathan H Varady
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Olivia Leonovicz
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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15
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Alqahtani SM, Alzahrani MM, Bicknell R, Pichora D. Prevalence and factors of work-related musculoskeletal disorders among hand surgeons. World J Orthop 2022; 13:465-471. [PMID: 35633751 PMCID: PMC9125005 DOI: 10.5312/wjo.v13.i5.465] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 11/12/2021] [Accepted: 04/24/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The nature of tasks required by hand surgeons require both forceful and repetitive maneuvers, thus subjecting these surgeons to the risk of musculoskeletal (MSK) injuries during their years in practice.
AIM To assess the prevalence, characteristics and impact of MSK disorders among hand surgeons.
METHODS A modified version of the physical discomfort survey was sent to surgeons who were members of the American Society for Surgery of the Hand via e-mail. The collected data were analyzed using descriptive statistics, one-way analysis of variance, and Fisher's exact test. P values of < 0.05 were considered statistically significant.
RESULTS Of the 578 respondents, 60.4% reported that they had sustained a work-related MSK injury, of which the most common diagnoses were lateral elbow epicondylitis (18.7%), low back pain (17.1%) and carpal tunnel syndrome (15.6%). Among those that reported an injury, 73.1 % required treatment and 29.2 % needed time off work as a direct result of their injury. The number of work-related injuries incurred by a surgeon increased significantly with increasing age (P < 0.003), increasing years in practice (P < 0.001) and higher case load (P < 0.05).
CONCLUSION To our knowledge this study is the first of its kind to assess MSK injuries sustained by Hand surgeons with a high incidence. These results should increase awareness on this aspect and fuel future studies directed at preventing these types of work-related injuries, thus minimizing the financial and psychological burden on these surgeons and the healthcare system.
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Affiliation(s)
- Saad M Alqahtani
- Department of Orthopaedics, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Mohammad M Alzahrani
- Department of Orthopaedics, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Ryan Bicknell
- Department of Orthopaedics, Queens University, Kingston K7L 3N6, Ontario, Canada
| | - David Pichora
- Department of Orthopaedics, Queens University, Kingston K7L 3N6, Ontario, Canada
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16
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Fouché TW, Bond SM, Vrouwe SQ. Comparing the Efficiency of Tumescent Infiltration Techniques in Burn Surgery. J Burn Care Res 2022; 43:525-529. [PMID: 35396595 DOI: 10.1093/jbcr/irac026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Tangential excision and grafting of burn wounds result in significant intraoperative blood loss, and infiltration of a dilute epinephrine solution (tumescence) is routinely performed to reduce such bleeding. Tumescent infiltration has been described using both a manual technique (syringe) and a pump device. The purpose of this study is to compare the efficiency of these two methods in terms of time and economy of motion. Consecutive adult burn patients at a single center requiring excision and grafting were enrolled in the study and randomized into either the manual or pump technique. Excisions involving less than 2% TBSA were excluded, along with specific anatomic regions (eg, head and neck). Infiltration with epinephrine solution (1:500,000) was performed to the endpoint of tumescence by a single surgeon and filmed/coded for duration, number of maneuvers, and volume of tumescence injected. Fourteen patients were enrolled, and 16 cases were randomized to either manual (N = 8) or pump infiltration (N = 8). The pump method required less time (2.0 vs 1.1 cm2/s, P < .001) and fewer maneuvers (37.8 vs 1.1 cm2/move, P < .001) to reach the desired endpoint of tumescence. Use of the infiltration pump also resulted in a reduced volume of tumescent fluid required to reach this point of tumescence (1.7 vs 2.4 mL/cm2, P = .01). Compared to the manual technique, an infiltration pump was significantly more efficient in terms of both time and economy of motion. These reductions are potentially useful for improving operating room efficiency as well as minimizing operator fatigue.
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Affiliation(s)
- Tom W Fouché
- Pritzker School of Medicine, University of Chicago, Illinois, USA
| | - Stephanie M Bond
- Section of Plastic & Reconstructive Surgery, University of Chicago, Illinois, USA
| | - Sebastian Q Vrouwe
- Section of Plastic & Reconstructive Surgery, University of Chicago, Illinois, USA
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17
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Occupational Hazards for the Practicing Orthopaedic Surgeon: A Standard Review. J Am Acad Orthop Surg 2022; 30:e607-e616. [PMID: 35171850 DOI: 10.5435/jaaos-d-21-00612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 12/06/2021] [Indexed: 02/01/2023] Open
Abstract
Level V.
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18
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Operation-related Musculoskeletal Injuries among United States Surgeons: A Gender-stratified National Survey. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2022; 10:e4142. [PMID: 35198358 PMCID: PMC8856129 DOI: 10.1097/gox.0000000000004142] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/21/2021] [Indexed: 11/23/2022]
Abstract
UNLABELLED Operation-related musculoskeletal injury (ORMI) among surgeons is a well-described phenomenon. Our study aimed to determine the prevalence of self-reported ORMI among surgeons of various subspecialties and preliminarily investigate the role of gender. METHODS An anonymous survey, querying information pertinent to ORMIs, was distributed online through the American College of Surgeons community membership forum. Nonparametric univariate analysis and a multivariate regression model were conducted. A P value of 0.05 determined significance. RESULTS A total of 624 male and female surgeons responded to the survey, with 50.8% reporting having an injury related to operating. Among the entire cohort, the prevalence of ORMI was significantly higher among female surgeons than male surgeons (P = 0.01), although there was no significant difference among the genders in ORMI prevalence when stratifying by age group (all P > 0.05). CONCLUSION Female surgeons are more likely to report an ORMI, although the impact of confounding variables such as age, operative case volume, and surgical subspecialty remain to be fully elucidated.
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19
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Prevalence of Back and Neck Pain in Orthopaedic Surgeons in Western New York. J Am Acad Orthop Surg Glob Res Rev 2022; 6:01979360-202201000-00007. [PMID: 34989709 PMCID: PMC8740880 DOI: 10.5435/jaaosglobal-d-21-00252] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022]
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20
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Alzahrani MM, Alqahtani SM, Pichora D, Bicknell R. Work-related musculoskeletal injuries among upper extremity surgeons: A web-based survey. World J Orthop 2021; 12:891-898. [PMID: 34888149 PMCID: PMC8613686 DOI: 10.5312/wjo.v12.i11.891] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 07/28/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Work-related injuries have gained recent attention, especially in the orthopaedic literature. As upper extremity orthopaedic surgical tasks require repetitive and constant maneuvers, these surgeons can be at increased risk of acquiring work-related musculoskeletal (MSK) disorders during their years in practice.
AIM To assess the prevalence, characteristics and impact of MSK disorders among upper extremity orthopaedic surgeons.
METHODS A modified version of the physical discomfort survey was sent to surgeons who were members of the American Shoulder and Elbow Surgeons and the Canadian shoulder and elbow society via e-mail. The collected data were analyzed using descriptive statistics, one-way analysis of variance, and Fisher's exact test. P values of < 0.05 were considered statistically significant.
RESULTS Of the 142 respondents, 90.8% were males and the majority were younger than 55 years old (65.5%). A work-related MSK injury was reported by 89.4% of respondents, of which the most common diagnoses were low back pain (26.1%) and lateral elbow epicondylitis (18.3%). Among those that reported an injury, 82.7% required treatment and 26% required time off work as a direct result of their injury. The need to undergo treatment due to the injury was associated with increased number of injuries (P < 0.01). Moreover, surgeons were more likely to require time off work when they had been in practice for > 21 years (P < 0.05).
CONCLUSION A high proportion of surgeons in our survey reported MSK injuries, with more than one quarter of surgeons reported requiring time off work due to an MSK injury. The high incidence of these disorders may place a financial and psychological burden on surgeons and affect their ability to provide patient care. Awareness of operative ergonomics, irrespective of surgical specialty may help to decrease or possibly prevent the occurrence of these disorders.
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Affiliation(s)
- Mohammad M Alzahrani
- Department of Orthopaedics, Imam Adulrahman Bin Faisal University, Dammam, KSA 34212, Saudi Arabia
| | - Saad M Alqahtani
- Department of Orthopaedics, Imam Adulrahman Bin Faisal University, Dammam, KSA 34212, Saudi Arabia
| | - David Pichora
- Department of Orthopaedics, Queens University, Kingston K7L 3N6, Canada
| | - Ryan Bicknell
- Department of Orthopaedics, Queens University, Kingston K7L 3N6, Canada
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21
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Kopkash K, Novak K, Murphy R, Deliere A, Kuchta K, Rabbitt S, Pesce C, Winchester D, Yao K. Improving the Breast Surgeon's Ergonomic Workload for Nipple-Sparing Mastectomies Using Exercise and Operating Room Positioning Protocol. Ann Surg Oncol 2021; 28:5698-5706. [PMID: 34318384 DOI: 10.1245/s10434-021-10447-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/16/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The objective of this study was to examine whether an exercise program and standardized operating room positioning protocol (EOPP) would improve surgeon muscle workload and/or surgeon perception of mental/physical workload for nipple-sparing mastectomy (NSM). METHODS This prospective study analyzed muscle workload by EMG of four surgeons performing NSM before and after an EOPP. Surveys were administered assessing surgeon perception of mental/physical workload. EMG data were analyzed using repeated-measures ANOVA, controlling for surgeon, first assistant, duration and difficulty of procedure, left or right side, and sequence of the procedure. RESULTS A total of 56 NSM cases performed by 3 surgeons were analyzed. One surgeon was excluded because of muscle injury and undergoing active physical therapy during the study period. After implementation of the EOPP, the left (P = 0.005) and right (P = 0.020) upper trapezii muscles had a significant decrease in overall ergonomic workload but there was no significant change in overall ergonomic workload for the bilateral cervical erector spinae, anterior deltoid, and lumbar erector spinae muscle groups. When analyzing muscle group exertion by surgeon, there was significant variability in all muscles except the left cervical erector spinae. Following the EOPP, surgeons reported that the procedures were more physically (P = 0.01) and mentally (P = 0.002) demanding and visualization (P = 0.04) was worse. The breast laterality and sequence did not affect muscle exertion. CONCLUSIONS An EOPP decreased the overall ergonomic workload of one muscle group for surgeons performing NSM but did not impact surgeon perception of mental/physical workload. Further investigation is needed to improve surgeon ergonomics.
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Affiliation(s)
- Katherine Kopkash
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA. .,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA.
| | - Kevin Novak
- Department of Neurophysiology, NorthShore University HealthSystem, Evanston, IL, USA
| | | | - Amanda Deliere
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Kristine Kuchta
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Sarah Rabbitt
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Catherine Pesce
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - David Winchester
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
| | - Katharine Yao
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA.,Pritzker School of Medicine, University of Chicago, Chicago, IL, USA
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22
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Short C, Basuino M, Segalini N, Rialon KL, Brandt ML. Working Through the Pain: Surgical Culture and Musculoskeletal Injury. CURRENT SURGERY REPORTS 2021. [DOI: 10.1007/s40137-021-00295-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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