BOSTON – For many surgeons, hours in the OR can translate into serious or chronic neck, back, and hand pain.
Studies of occupational injury related to performing surgery took off in the 1990s when laparoscopic surgery became widespread and put new physical demands on surgeons (Surg Endosc 1999:13:466-468; Arch Surg 1999;134:1011-1016). Findings from a study presented at the Society for Surgical Oncology suggest that the problem remains widespread.
Dr. Rachael K. Voss, a research resident at the University of Texas MD Anderson Cancer Center, Houston, and her colleagues conducted a survey among oncologic surgeons at the Center to explore the extent, sources and risk factors of workplace injuries.
“[Workplace injury] is a serious issue for surgeons, but it is something we don’t talk about and there is very little training and information as we are going through training. But these occupational hazards are something we need to acknowledge. We need to do more work in the future with ergonomics experts and occupational hygiene experts that can help us improve our posture and positions in the OR so we can prevent these injuries,” Dr. Voss said.
A high response rate of 58% yielded a total of 127 completed surveys. Most of the respondents were aged 35-64 and three-quarters spent 10 hours or more per week working in the OR. Among those responding, 92.3% experienced at least one occupation-related symptom over the past 6 weeks, and 27.6% reported sustaining an injury or chronic condition which they attributed to operating. The majority of injuries reported were cervical spine injury, musculoskeletal fatigue and vertebral disc injury. Other conditions mentioned were brachial plexus damage, carpal tunnel syndrome, peripheral neuropathy, and tendonitis.
A multivariate analysis identified some independent risk factors for injury: male gender, average case duration of 4 hours or longer, neck pain, and frequent use of a step for height adjustment. Age and years in practice were not associated with injury risk.
The good news is that, in this sample, 72% of the respondents reported seeking treatment for their injury. Physical therapy and medication were the most commonly utilized treatments, with about 20% resorting to surgery.
Plenty of evidence
The MD Anderson findings confirmed what other studies in this area have reported. William T. Davis and his colleagues surveyed Fellows of the Tennessee chapter of the American College of Surgeons on the issue of occupational musculoskeletal injury (J Surg Res 2014;184:207-212). Of the 793 surveys sent, 33% were completed. General surgeons accounted for 64% of respondents and 80% were male. Forty percent of respondents had sustained at least one injury related to operating. Most reported spine, hand, and neck injuries, but hip, knee, and shoulder pain was also mentioned. The majority of respondents reported the cause of their injury as chronic and 51% sought medical treatment. As with the MD Anderson study, no association was found between age or years in practice and workplace injury.
Mr. Davis and his colleagues conducted a similar study of orthopaedic surgeons and found similar rates of occupational injury (44%) among their 140 survey respondents (J Bone Joint Surg Am. 2013;95:e107). This study found that responding orthopaedic surgeons had more hand and lower back injuries, and correlation was found between years in practice and prevalence of injury.
A limitation of all of these studies is that the injury data are self-reported, and there is a potential selection bias. It is likely that the true extent of workplace injury among surgeons, and the costs and impact on surgeons’ life quality and productivity, are still largely unknown.
“There have been a few studies on this, but I think we’re just scratching the surface,” explained Dr. Adrian Park, chair of surgery at the Anne Arundel Medical Center in Annapolis, Md. Dr. Park was the lead author of a 2010 study that identified chronic pain among surgeons as a serious and underreported issue within medicine (J Am Coll Surg 2010;210;306-313).
The study, which evaluated 317 surgeons using a 23-question survey, found that 86.9% of surgeons experience “physical symptoms or discomfort,” with the most significant indicator of such symptoms being a high case load. Subsequent studies from Europe and eastern Asia also found rates of 80% or higher among surgeons in those regions.
With so pervasive a problem, however, the relative paucity of data and conversation among medical professionals is something Dr. Park finds alarming. “As a surgeon leader, I can tell you surgeons complain about a lot of stuff, but one of the things they tend not to complain about is themselves and their own health and well-being,” said Dr. Park.