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Gonzales A, Barbieri DF, Carbonell AM, Joseph A, Srinivasan D, Cha J. The compatibility of exoskeletons in perioperative environments and workflows: an analysis of surgical team members' perspectives and workflow simulation. ERGONOMICS 2024; 67:674-694. [PMID: 37478005 DOI: 10.1080/00140139.2023.2240045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/15/2023] [Indexed: 07/23/2023]
Abstract
Surgical team members in perioperative environments experience high physical demands. Interventions such as exoskeletons, external wearable devices that support users, have the potential to reduce these work-related physical demands. However, barriers such as workplace environment and task compatibility may limit exoskeleton implementation. This study gathered the perspectives of 33 surgical team members: 12 surgeons, four surgical residents, seven operating room (OR) nurses, seven surgical technicians (STs), two central processing technicians (CPTs), and one infection control nurse to understand their workplace compatibility. Team members were introduced to passive exoskeletons via demonstrations, after which surgical staff (OR nurses, STs, and CPTs) were led through a simulated workflow walkthrough where they completed tasks representative of their workday. Five themes emerged from the interviews (workflow, user needs, hindrances, motivation for intervention, and acceptance) with unique subthemes for each population. Overall, exoskeletons were largely compatible with the duties and workflow of surgical team members.
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Affiliation(s)
- Alec Gonzales
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| | | | - Alfredo M Carbonell
- Department of Surgery, Prisma Health - Upstate, Greenville, South Carolina, USA
- University of South Carolina School of Medicine-Greenville, Greenville, South Carolina, USA
| | - Anjali Joseph
- School of Architecture, Clemson University, Clemson, South Carolina, USA
| | - Divya Srinivasan
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
| | - Jackie Cha
- Department of Industrial Engineering, Clemson University, Clemson, South Carolina, USA
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Pillado E, Li RD, Chia MC, Eng JS, DiLosa K, Grafmuller L, Conway A, Escobar GA, Shaw P, Sheahan MG, Bilimoria KY, Hu YY, Coleman DM. Reported pain at work is a risk factor for vascular surgery trainee burnout. J Vasc Surg 2024; 79:1217-1223. [PMID: 38215953 DOI: 10.1016/j.jvs.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/30/2023] [Accepted: 01/04/2024] [Indexed: 01/14/2024]
Abstract
BACKGROUND Work-related pain is a known risk factor for vascular surgeon burnout. It risks early attrition from our workforce and is a recognized threat to the specialty. Our study aimed to understand whether work-related pain similarly contributed to vascular surgery trainee well-being. METHODS A confidential, voluntary survey was administered after the 2022 Vascular Surgery In-Service Examination to trainees in all Accreditation Council for Graduate Medical Education-accredited vascular surgery programs. Burnout was measured by a modified, abbreviated Maslach Burnout Inventory; pain after a full day of work was measured using a 10-point Likert scale and then dichotomized as "no to mild pain" (0-2) vs "moderate to severe pain" (3-9). Univariable analyses and multivariable regression assessed associations of pain with well-being indicators (eg, burnout, thoughts of attrition, and thoughts of career change). Pain management strategies were included as additional covariables in our study. RESULTS We included 527 trainees who completed the survey (82.2% response rate); 38% reported moderate to severe pain after a full day of work, of whom 73.6% reported using ergonomic adjustments and 67.0% used over-the-counter medications. Significantly more women reported moderate to severe pain than men (44.3% vs 34.5%; P < .01). After adjusting for gender, training level, race/ethnicity, mistreatment, and dissatisfaction with operative autonomy, moderate-to-severe pain (odds ratio, 2.52; 95% confidence interval, 1.48-4.26) and using physiotherapy as pain management (odds ratio, 3.06; 95% confidence interval, 1.02-9.14) were risk factors for burnout. Moderate to severe pain was not a risk factor for thoughts of attrition or career change after adjustment. CONCLUSIONS Physical pain is prevalent among vascular surgery trainees and represents a risk factor for trainee burnout. Programs should consider mitigating this occupational hazard by offering ergonomic education and adjuncts, such as posture awareness and microbreaks during surgery, early and throughout training.
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Affiliation(s)
- Eric Pillado
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Ruojia Debbie Li
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Matthew C Chia
- Northwestern Quality Improvement, Research, & Education in Surgery (NQUIRES) Department of Surgery, Northwestern University, Chicago, IL
| | - Joshua S Eng
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Kathryn DiLosa
- Division of Vascular Surgery, Department of Surgery, University of California, Davis, Sacramento, CA
| | - Leanne Grafmuller
- Division of Vascular Surgery, Department of Surgery, University of Rochester, Rochester, NY
| | - Allan Conway
- Division of Vascular Surgery Lenox Hill Hospital, Department of Surgery, Northwell Health, New York, NY
| | - Guillermo A Escobar
- Division of Vascular Surgery, Department of Surgery, Emory University, Atlanta, GA
| | - Palma Shaw
- Division of Vascular Surgery, Upstate Medical University, Syracuse, NY
| | - Malachi G Sheahan
- Division of Vascular and Endovascular Surgery, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Karl Y Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Yue-Yung Hu
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Indiana University, Indianapolis, IN
| | - Dawn M Coleman
- Division of Vascular and Endovascular Surgery, Department of Surgery, Duke University, Durham, NC.
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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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Morse E, Harpel L, Born H, Rameau A. Female Surgical Ergonomics in Otolaryngology: A Qualitative Study. Laryngoscope 2023; 133:3034-3041. [PMID: 37096670 PMCID: PMC10593046 DOI: 10.1002/lary.30711] [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: 12/15/2022] [Revised: 03/22/2023] [Accepted: 04/09/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE To explore the surgical ergonomic challenges experienced by women in otolaryngology, identify specific equipment that is ergonomically challenging, and assess the impact of suboptimal ergonomics on female otolaryngologists. METHODS We performed a qualitative study using an interpretive framework rooted in grounded theory. We performed semi-structured qualitative interviews of 14 female otolaryngologists from nine institutions at various stages in training and across subspecialties. Interviews were independently analyzed by thematic content analysis by two researchers and inter-rater reliability was assessed via Cohen's kappa. Differing opinions were reconciled via discussion. RESULTS Participants noted difficulties with equipment including microscopes, chairs, step stools, and tables as well as difficulty using larger surgical instruments, preference for smaller instruments, frustration with lack of smaller instruments, and a desire for a larger spectrum of instrument sizes. Participants reported neck, hand, and back pain associated with operating. Participants suggested modifications to the operative environment, including a wider variety of instrument sizes, adjustable instruments, and more focus and attention on ergonomic issues and the range of surgeon physiques. Participants felt that optimizing their operating room set-up was an additional burden on them, and that lack of inclusive instrumentation affected their sense of belonging. Participants emphasized positive stories of mentorship and empowerment from peers and superiors of all genders. CONCLUSION Female otolaryngologists face unique ergonomic challenges. As the otolaryngology workforce becomes increasingly diverse, it is important to address the needs of a diverse set of physiques to avoid inadvertently disadvantaging certain individuals. LEVEL OF EVIDENCE N/A Laryngoscope, 133:3034-3041, 2023.
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Affiliation(s)
- Elliot Morse
- Weill Cornell Medicine, New York, NY, Department of Otolaryngology-Head and Neck Surgery
| | - Lexa Harpel
- Weill Cornell Medicine, New York, NY, Department of Otolaryngology-Head and Neck Surgery
| | - Hayley Born
- Weill Cornell Medicine, New York, NY, Department of Otolaryngology-Head and Neck Surgery
- Sean Parker Institute for the Vloice, Weill Cornell Medicine, New York New York USA
| | - Anaïs Rameau
- Weill Cornell Medicine, New York, NY, Department of Otolaryngology-Head and Neck Surgery
- Sean Parker Institute for the Vloice, Weill Cornell Medicine, New York New York USA
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Strait AV, Ho H, Parks NL, Hamilton WG, McAsey CJ, Sershon RA. Does Powered Femoral Broaching Compromise Patient Safety in Total Hip Arthroplasty? Arthroplast Today 2023; 23:101198. [PMID: 37745960 PMCID: PMC10514414 DOI: 10.1016/j.artd.2023.101198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/23/2023] [Accepted: 07/19/2023] [Indexed: 09/26/2023] Open
Abstract
Background During manual broaching (MB) in total hip arthroplasty (THA), off-axis forces delivered to the proximal femur and broach malalignment can lead to fractures and cortical perforations. Powered broaching (PB) is a novel alternative that delivers consistent impaction forces and reduces workload. This is the first large-scale study to compare intraoperative and 90-day rates of periprosthetic femur fractures (PFFs) and perforations in THA performed using MB vs PB. Methods Our institutional database was reviewed for all patients undergoing primary cementless direct anterior THA from 2016 to 2021. Three surgeons performing 2048 THAs (MB = 800; PB = 1248) using the same stem design were included. PFFs and perforations within 90 days of the index procedure were compared. Differences in length of surgery and demographics were assessed. Results Calcar fractures occurred in <1% of patients (PB [0.96%, 12/1248] vs MB [0.25%, 2/800]; P = .06). Rates of trochanteric fractures did not differ (PB = 0.32% [4/1248] vs MB = 0.38% [3/800]; P = .84). Cortical perforations occurred in 0.24% (3/1248) of the PB cohort and in 0.75% (6/800) of the MB cohort (P = .09). No revisions due to aseptic loosening or PFF occurred within 120 days of surgery. Conclusions Our single-center experience with powered femoral broaching in THA demonstrates PB is a safe and efficient means of performing direct anterior THA. Low rates (<1%) of PFF, perforation, and revision can be achieved. Given our positive experience with PB, all surgeon authors utilize PB nearly exclusively for elective primary direct anterior THA.
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Affiliation(s)
- Alexander V. Strait
- Georgetown University School of Medicine, Washington, DC, USA
- Anderson Orthopaedic Research Institute, Alexandria, VA, USA
| | - Henry Ho
- Anderson Orthopaedic Research Institute, Alexandria, VA, USA
| | - Nancy L. Parks
- Anderson Orthopaedic Research Institute, Alexandria, VA, USA
| | - William G. Hamilton
- Anderson Orthopaedic Research Institute, Alexandria, VA, USA
- Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, VA, USA
| | - Craig J. McAsey
- Anderson Orthopaedic Research Institute, Alexandria, VA, USA
- Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, VA, USA
| | - Robert A. Sershon
- Anderson Orthopaedic Research Institute, Alexandria, VA, USA
- Inova Mount Vernon Hospital Joint Replacement Center, Alexandria, VA, USA
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Al Mulhim FA, AlSaif HE, Alatiyah MH, Alrashed MH, Balghunaim AA, Almajed AS. The Prevalence of Musculoskeletal Pain (MSP) Among Orthopedic Surgeons and Residents in Saudi Arabia's Eastern Area. Cureus 2023; 15:e39246. [PMID: 37342747 PMCID: PMC10277320 DOI: 10.7759/cureus.39246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Orthopedic surgery is a tiring specialty both physically and mentally. Surgeons tend to hold strenuous postures for long periods of time. Orthopedic surgery residents are affected just as much as their seniors by the difficult ergonomics. More care should be aimed toward healthcare professionals to improve patient outcomes and decrease the burden on our surgeons. The goal of this study is to pinpoint the areas of musculoskeletal pain among orthopedic surgery physicians and residents and its prevalence in the eastern province of Saudi Arabia. METHODS A cross-sectional study was conducted in the Eastern region of Saudi Arabia. A simple random selection of 103 male and female orthopedic surgery residents from Saudi Commission for Health Specialties accredited hospitals was enrolled in the study. Residents enrolled from the first to fifth year. Data were collected using a self-administered online questionnaire based on the musculoskeletal Nordic questionnaire activated in 2022-2023. RESULTS Out of 103, a total of 83 completed the survey. The majority (49.9%) were junior residents from residency year (R) 1-R3 and exactly 52 (62.7%) residents were males. The majority of the participants, which were 35 physicians (55.6%), perfume less than six operations as average operations per week, and duration stay in the operating room (OR) per operation there were 29 physicians (46%) stay in the OR for 3-6 h. The most reported sites of pain included lower back pain (46%), followed by neck pain (39.7%) and then upper back pain (30.2%). About 27% of the participants had the pain for more than 6 months, however, only 7 (11.1%) residents seek for medical help. Considering the associated factors with MSP, smoking, and residency year were significantly associated with having musculoskeletal pain (MSP). The presence of MSK pain among R1 residents represents 89.5%, in comparison with R2 residents Who reported 63.6% and 66.7% among R5 residents. This finding indicates a decrease in MSP among residents over the 5 years of residency programs. Additionally, the majority of the participants with MSP reported being smokers 24 (88.9%), controversy, only three of the participants represent (11.1%) without MSP and smokers. CONCLUSIONS Musculoskeletal pain is a serious issue that needs to be addressed. The results indicate that the most reported areas of MSP were the low back, neck, and upper back. Only a minority of the participants went to seek medical help. Residents from R1 experienced more MSP than their seniors and this could indicate an adaptive behavior from senior staff. More research should be done on the topic of MSP in order to promote health among caregivers across the kingdom.
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Affiliation(s)
| | - Hajer E AlSaif
- College of Medicine, King Faisal University, Al-Ahssa, SAU
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UKA with a handheld robotic device results in greater surgeon physiological stress than conventional instrumentation. Knee Surg Sports Traumatol Arthrosc 2023; 31:777-785. [PMID: 35188582 DOI: 10.1007/s00167-022-06908-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 01/23/2022] [Indexed: 10/19/2022]
Abstract
PURPOSE Poor ergonomics and acute stress can impair surgical performance and cause work-related injuries. Robotic assistance may optimize these psychophysiological factors during UKA. This study compared surgeon physiologic stress and ergonomics during robotic-assisted UKA (rUKA) and conventional UKA (cUKA). METHODS Cardiorespiratory and postural data from a single surgeon were recorded during 30 UKAs, (15 rUKAs, 15 cUKAs). Heart rate (HR), HR variability, respiratory rate (RR), minute ventilation and calorie expenditure were used to measure surgical strain. Intraoperative ergonomics were assessed by measuring flexion/extension/rotation of the neck and lumbar spine, and shoulder abduction/adduction. RESULTS Mean operative time was 32.0 ± 7 min for cUKA and 45.9 ± 9 min for rUKA (p < 0.001). Mean neck flexion was - 23.4° ± 13° for rUKA and - 49.1° ± 18 for cUKA (p < 0.001), while mean lumbar flexion was - 20.3° ± 30° for rUKA and - 0.4° ± 68° for cUKA (p = 0.313). Mean lumbar flexion was similar; however, a significantly greater percentage of time was spent in lumbar flexion > 20° during cUKA. Bilateral shoulder abduction was significantly higher for rUKA. Mean calorie expenditure was 154 cal for rUKA and 89.1 cal for cUKA (p < 0.001). Mean HR was also higher for rUKA (88.7 vs. 84.7, p = 0.019). HR variability was slightly lower for rUKA (12.4) than for cUKA (13.4), although this did not reach statistical significance (p = 0.056). No difference in RR or minute ventilation was observed. CONCLUSION rUKA resulted in less neck flexion but increased shoulder abduction, heart rate, and energy expenditure. The theoretical ergonomic and physiologic advantages of robotic assistance using a handheld sculpting device were not realized in this study. LEVEL OF EVIDENCE II.
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Moving beyond radiographic alignment: applying the Wald Principles in the adoption of robotic total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2023; 47:365-373. [PMID: 35532787 PMCID: PMC9877041 DOI: 10.1007/s00264-022-05411-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 04/18/2022] [Indexed: 01/29/2023]
Abstract
The use of robotics in total knee arthroplasty (TKA) is growing at an exponential rate. Despite the improved accuracy and reproducibility of robotic-assisted TKA, consistent clinical benefits have yet to be determined, with most studies showing comparable functional outcomes and survivorship between robotic and conventional techniques. Given the success and durability of conventional TKA, measurable improvements in these outcomes with robotic assistance may be difficult to prove. Efforts to optimize component alignment within two degrees of neutral may be an attainable but misguided goal. Applying the "Wald Principles" of rationalization, it is possible that robotic technology may still prove beneficial, even when equivalent clinical outcomes as conventional methods, if we look beyond the obvious surrogate measures of success. Robotic systems may help to reduce inventory, streamline surgical trays, enhance workflows and surgical efficiency, optimize soft tissue balancing, improve surgeon ergonomics, and integrate artificial intelligence and machine learning algorithms into a broader digital ecosystem. This article explores these less obvious alternative benefits of robotic surgery in the field of TKA.
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Gu J, Ni J, Ma Y, Xiong Y, Zhou J. The height of the operating table affects the performance of residents in combined spinal and epidural anesthesia training by affecting the vision of the puncture needle: a randomized controlled trial. BMC Anesthesiol 2023; 23:28. [PMID: 36650434 PMCID: PMC9843990 DOI: 10.1186/s12871-023-01985-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 01/13/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The present study aimed to evaluate whether the operating table height affected the success rate and incidences of complications of combined spinal-epidural anesthesia administered by residents during training. METHODS One-hundred-and-eighty patients were randomly allocated according to landmarks on the resident's body: umbilicus (group U), lowest rib margin (R), and xiphoid process (X). The success rates of combined spinal-epidural anesthesia, and the incidences of paresthesia and vessel trauma were recorded. RESULTS There were no differences between the three groups in the success rates of combined spinal-epidural anesthesia, and the incidences of paresthesia and vessel trauma. However, paresthesia during epidural catheter advancement was more common on the left side (66.7%) than the right side (33.3%) (P = 0.03). In group R, the success rate of epidural anesthesia was higher during the residents' third time (100%) than their first time (50%; P = 0.01). Most residents (83%) preferred the table height at which the needle insertion point was at the level of their lowest rib margin. CONCLUSIONS Neither the success nor the complication of combined spinal-epidural anesthesia in lateral decubitus position during residents' training affected by the operating table height. However, paresthesia was more likely to occur on the left side when a stiff catheter was inserted into the epidural space. It may be better to keep the table height at residents' lowest rib margin. It was not just preferred by most of residents but also better for their training of performing epidural anesthesia. TRIAL REGISTRATION The trial was registered prior to patient enrollment at Chinese Clinical Trial Registry (NCT: ChiCTR1800016078, Principal investigator: Juan Gu, Date of registration: 9 May 2018). Registry URL http://www.chictr.org.cn.
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Affiliation(s)
- Juan Gu
- grid.13291.380000 0001 0807 1581Department of Anesthesiology, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education. 20#, Section 3 Renmin Nan Road, Chengdu, Sicuan, Chengdu, 610041 China
| | - Juan Ni
- grid.13291.380000 0001 0807 1581Department of Anesthesiology, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education. 20#, Section 3 Renmin Nan Road, Chengdu, Sicuan, Chengdu, 610041 China
| | - Yushan Ma
- grid.13291.380000 0001 0807 1581Department of Anesthesiology, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education. 20#, Section 3 Renmin Nan Road, Chengdu, Sicuan, Chengdu, 610041 China
| | - Yaqin Xiong
- grid.13291.380000 0001 0807 1581Department of Anesthesiology, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education. 20#, Section 3 Renmin Nan Road, Chengdu, Sicuan, Chengdu, 610041 China
| | - Jin Zhou
- grid.13291.380000 0001 0807 1581Department of Anesthesiology, West China Second University Hospital, Sichuan University; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education. 20#, Section 3 Renmin Nan Road, Chengdu, Sicuan, Chengdu, 610041 China
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Smith TG, Lowndes BR, Schmida E, Lund SB, Linden AR, Rivera M, Gas BL, Hallbeck MS. Course Design and Learning Outcomes of a Practical Online Ergonomics Course for Surgical Residents. JOURNAL OF SURGICAL EDUCATION 2022; 79:1489-1499. [PMID: 35907697 DOI: 10.1016/j.jsurg.2022.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 05/23/2022] [Accepted: 07/05/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Course content was designed and the learning outcomes assessed for an online ergonomics course for surgical residents. This course could fulfill an optional Surgical Council on Resident Education (SCORE) curriculum on Surgical Ergonomics. DESIGN The online course included five 5-minute modules within the residents' learning system, each ending with an ungraded knowledge question, and a final 5-question multiple-choice retention quiz that allowed infinite attempts. The course was designed by ergonomists and surgeons at a quaternary academic hospital system. Participants were given two weeks to complete the modules. An electronic survey with questions assessing ergonomics knowledge and understanding on a 5-point Likert scale (strongly disagree - strongly agree) was distributed both before and after the course. The post-course survey included three additional questions to elicit feedback regarding learning experience and course design. Descriptive statistics and nonparametric paired comparisons were used to evaluate learning outcomes. SETTING General surgery residency program at an academic medical center in the U.S. PARTICIPANTS Twenty-two general surgery post graduate year 1 residents (PGY1s) were recruited to participate and completed the pre-course survey. Eight out of the 22 participants (36%) completed the online course and quiz; seven (32%) completed the course, quiz, and the post-course survey. RESULTS Participants had high pre-course awareness of the importance of surgical ergonomics, benefits of work-related musculoskeletal disorder (WMSD) prevention, as well as awkward intraoperative postures being an WMSD risk factor. Participants' confidence increased significantly from pre- to post-course in ability to assess risk (p = 0.021), but not in ability or willingness to mitigate risky surgical postures. Participants who completed the quiz answered a median of 4 (IQR: [4, 5]) questions correctly. All participants indicated that they would recommend this course to other residents. CONCLUSIONS These short practical ergonomics online learning modules increased surgical residents' confidence in assessing surgical WMSD risks.
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Affiliation(s)
- Tianqi G Smith
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | | | - Elizabeth Schmida
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Sarah B Lund
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Anna R Linden
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Mariela Rivera
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - Becca L Gas
- Department of Surgery, Mayo Clinic, Rochester, Minnesota
| | - M Susan Hallbeck
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota; Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota; Department of Surgery, Mayo Clinic, Rochester, Minnesota.
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Bellini MI, Amabile MI, Saullo P, Zorzetti N, Testini M, Caronna R, D’Andrea V. A Woman's Place Is in Theatre, but Are Theatres Designed with Women in Mind? A Systematic Review of Ergonomics for Women in Surgery. J Clin Med 2022; 11:jcm11123496. [PMID: 35743578 PMCID: PMC9225169 DOI: 10.3390/jcm11123496] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/30/2022] [Accepted: 06/15/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Literature regarding ergonomic protocols for surgery is lacking, and there is a paucity of information on how this impacts on gender differences with regards to the barriers faced by women in surgery. Methods: This article reviews current literature addressing women in surgery and ergonomics through a systematic search including the Web of Science, Scopus, and PubMed databases. Results: Searches retrieved 425 items, and after a thorough evaluation for inclusion, 15 studies were examined—predominantly surveys (n = 9) and originating from the USA (n = 9). Identified ergonomic challenges included the general shorter height and smaller glove size of women. Furthermore, women experienced more musculoskeletal pain than men, potentially because the size and design of theatre tools are designed for male and tall individuals, highlighting an unconscious gender bias still pervading the surgical field. Conclusions: As more women enter medicine and pursue surgical careers, it is essential to foster a culture of diversity and inclusion in theatre to develop more ergonomic environments.
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Affiliation(s)
- Maria Irene Bellini
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.I.A.); (P.S.); (N.Z.); (M.T.); (R.C.); (V.D.)
- Correspondence: ; Tel.: +39-0649970385
| | - Maria Ida Amabile
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.I.A.); (P.S.); (N.Z.); (M.T.); (R.C.); (V.D.)
| | - Paolina Saullo
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.I.A.); (P.S.); (N.Z.); (M.T.); (R.C.); (V.D.)
| | - Noemi Zorzetti
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.I.A.); (P.S.); (N.Z.); (M.T.); (R.C.); (V.D.)
| | - Mario Testini
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.I.A.); (P.S.); (N.Z.); (M.T.); (R.C.); (V.D.)
- Academic Unit of General Surgery, Department of Biomedical Sciences and Human Oncology, School of Medical, University of Bari Aldo Moro, 70120 Bari, Italy
| | - Roberto Caronna
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.I.A.); (P.S.); (N.Z.); (M.T.); (R.C.); (V.D.)
| | - Vito D’Andrea
- Department of Surgical Sciences, Sapienza University of Rome, 00161 Rome, Italy; (M.I.A.); (P.S.); (N.Z.); (M.T.); (R.C.); (V.D.)
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