Physical discomfort, professional satisfaction, and burnout in vascular surgeons

Effects of a Passive Back-Support Exosuit on Erector Spinae and Abdominal Muscle Activity During Short-Duration, Asymmetric Trunk Posture Maintenance Tasks

OBJECTIVE

To examine the effects of asymmetry and lower extremity mobility restrictions on the effectiveness of a passive back-support exosuit in short-duration, static trunk flexion postures.

BACKGROUND

The effectiveness of trunk exoskeletons/suits for sagittally symmetric trunk posture maintenance has been investigated, but there has been limited study of the effects of asymmetric trunk postures or lower extremity motion restriction.

METHOD

Sixteen participants held trunk flexion postures involving trunk flexion (20°, 40°, 60°), asymmetry (0°, 30°), and lower extremity mobility (Free, Restricted) for 3 s. Participants held these postures with and without an exosuit while erector spinae and abdominal muscle activities were collected.

RESULTS

There were no significant interactions between exosuit and asymmetry or exosuit and lower extremity motion restrictions, indicating no significant effects of these factors on the effectiveness of the exosuit at reducing trunk muscle activity. The exosuit was found to be effective at reducing erector spinae muscle activity regardless of asymmetry of posture or lower extremity restrictions (average 21%, from 11.2% MVC to 8.8% MVC). The magnitude of the erector spinae activity at 60° of trunk flexion with the exosuit was similar to that seen at 20° without the exosuit.

CONCLUSION

The exosuit consistently provided biomechanical benefit through reduced activation of the erector spinae muscles and neither asymmetry of trunk posture nor lower extremity restriction influenced this effectiveness.

APPLICATION

Trunk exoskeletons/suits can reduce trunk muscle activation and understanding how characteristics of the trunk postures assumed impact these responses may help target tasks wherein these devices may be effective.

Don't Just Stand There. Rethinking the Ideal Body Posture for Otorhinolaryngologists

Surgeons have a high rate of work-related musculoskeletal injuries; an area that has received little attention. These injuries result in surgeons performing less efficiently, needing to take time off work, suffering higher rates of burnout, and may ultimately lead surgeons to retire earlier than planned. Otorhinolaryngologists are at particular risk for work-related musculoskeletal injuries. Beyond the clinician, sustaining such injuries can negatively impact patient safety. Ergonomic interventions have been used effectively to reduce work-related musculoskeletal injuries in other professions, yet not in surgery. With traditional teachings of ideal body postures to avoid injury and manual handling training being re-evaluated, it is important to explore evidence based interventions for reducing work-related musculoskeletal injuries in otorhinolaryngologists. New research encourages us to shift the focus away from the traditional one-size-fits-all approach to ergonomics and toward postural recommendations and education that promote a dynamic, individualized approach to avoiding sustained, static and awkward postures.

Ergonomics of bronchoscopy: good advice or a pain in the neck?

Interventional pulmonologists require a unique set of skills including precise motor abilities and physical endurance, but surprisingly the application of ergonomic principles in the field of bronchoscopy remains limited. This is particularly intriguing when considering the significant impact that poor ergonomics can have on diagnostic aptitude, income potential and overall health. It is therefore imperative to provide comprehensive education to physicians regarding the significance of ergonomics in their work, especially considering the introduction of advanced diagnostic and therapeutic procedures. By implementing simple yet effective measures (e.g. maintaining neutral positions of the wrist, neck and shoulder; adjusting the height of tables and monitors; incorporating scheduled breaks; and engaging in regular exercises), the risk of injuries can be substantially reduced. Moreover, objective tools are readily available to assess ergonomic postures and estimate the likelihood of work-related musculoskeletal injuries. This review aims to evaluate the current literature on the impact of procedure-related musculoskeletal pain on practising pulmonologists and identify modifiable factors for future research.

Quantifying the effectiveness of a passive trunk-support exosuit at reducing erector spinae muscle fatigue during a quasi-static posture maintenance task

The objective of this study was to explore the effectiveness of a passive back-support exosuit at reducing low back muscle fatigue during an 18-minute trunk posture maintenance task. On two separate days sixteen participants performed an 18-minute trunk posture profile that reflected trunk flexion postures observed during a challenging vascular surgery procedure. On one day they performed the procedure with the support of the exosuit, on the other day without. Test contractions were performed every three minutes to capture the time-dependent electromyographic activity of the bilateral erector spinae muscles. Time domain (amplitude) and frequency domain (median frequency) measures of erector spinae muscle fatigue were assessed. Results revealed that the exosuit significantly reduced the measures of erector spinae muscle fatigue in terms of both amplitude (6.1%) and median frequency (5.3%), demonstrating a fatigue reduction benefit of the exosuit in a realistic surgical posture maintenance task.

Burnout and Its Consequences among Vascular Surgeons and Trainees: A Danish National Survey

BACKGROUND

Burnout among physicians has widespread negative consequences. Little is known about burnout among European vascular surgeons (VS). A previously published study found that 82% of VS and vascular surgical trainees (VST) in Denmark experience burnout symptoms. The present study aimed to investigate work- and health-related consequences of burnout.

STUDY DESIGN

An electronic survey was distributed to all VS/VST in Denmark in January 2020. Validated assessment tools were used to measure burnout, mental health, and psychosocial work environment aspects.

RESULTS

Of 104 invited VS/VST, 82% (n = 85) completed the survey. VS accounted for 72% (n = 61) of the respondents, and 40% (n = 33) were female. Statistically significant associations were found between higher levels of burnout and a range of work- and health-related outcomes, including a sense of meaning at work, workplace commitment, conflicts between work and private life, work stress, sick leave, and depressive symptoms. VS/VST using pain medication daily or weekly had significantly higher burnout scores than respondents who rarely or never use pain medication. A significant association between burnout and job satisfaction and retention was found, with respondents indicating an intention to stay within the specialty having significantly lower burnout scores than those who considered leaving within 5 years. Among those who indicated leaving the specialty, 35% (n = 13) attributed this to their current working conditions.

CONCLUSIONS

Burnout among VS/VST in Denmark is negatively associated with various work- and health-related outcomes. The work environment seems to play an essential role in these associations, and alterations in workplace organization may remedy this situation.

Prevalence and associations between occupational diseases, emotional exhaustion, and dust mask anxiety among coal miners in Northern China

This study examined the prevalence and associations between occupational-related diseases, emotional exhaustion, and dust mask anxiety among coal miners in Northern China. The study sampled 506 miners from two coal mines in Northern China. Descriptive (frequency, percentages, and chi-square tests) and inferential (complementary log-log logistic regression) analyses were carried out to assess prevalence and associations. The prevalence of coal mining-related pulmonary diseases was 94%, with 40% and 37% reporting pneumoconiosis and bronchitis respectively. Emphysema and tuberculosis were less prevalent with a total prevalence of 5% while 12% of the miners reported two, three, or four of these diseases. For cardiovascular diseases, 66% of the miners reported 3H (hypertension, hyperlipemia, and hyperglycemia) while heart disease and cerebral infarction were reported by 6% and 2% of the miners respectively. Also, 5% and 2% of the miners reported two or all three of 3H, heart condition, and cerebral infarction. The overall prevalence of cardiovascular diseases was 81% while 82% and 63% of the miners reported experiencing some frequency of emotional exhaustion and dust mask anxiety respectively. The study also identified associations between mining-related diseases, emotional exhaustion, dust mask anxiety, and other demographic, personal habits and work-related factors. Miners with pulmonary diseases were more likely to experience emotional exhaustion and dust mask anxiety. Contrariwise, miners with cardiovascular diseases were less likely to experience dust mask anxiety. Factors such as age, engaging in physical exercises, rhinitis, source of pressure and shift system were also associated with emotional exhaustion and dust mask anxiety. These findings highlight the prevalence of occupational diseases, emotional exhaustion, and dust mask anxiety among coal miners in China. The study emphasizes the need for interventions to address health risks, improve work conditions, and support miners' well-being in the coal mining industry.

Optimizing ergonomics during open, laparoscopic, and robotic-assisted surgery: A review of surgical ergonomics literature and development of educational illustrations

BACKGROUND

The surgical profession is plagued with a high prevalence of work-related musculoskeletal disorders. While numerous interventions have been tested over the years, surgical ergonomics education is still uncommon.

METHODS

The available literature on surgical ergonomics was reviewed, and with input from surgeons, recommendations from the review were used to create pictorial reminders for open, laparoscopic, and robot-assisted surgical modalities. These simple pictorial ergonomic recommendations were then assessed for practicality by residents and surgeons.

RESULTS

A review of the current literature on surgical ergonomics covered evidence-based ergonomic recommendations on equipment during open and laparoscopic surgery, as well as proper adjustment of the surgical robot for robot-assisted surgeries. Ergonomic operative postures for the three modalities were examined, illustrated, and assessed.

CONCLUSIONS

The resulting illustrations of ergonomic guidelines across surgical modalities may be employed in developing ergonomic education materials and improving the identification and mitigation of ergonomic risks in the operating room.

A narrative review of the physiology and health effects of burnout associated with veterinarian-pertinent occupational stressors

Chronic workplace stress and burnout are serious problems in veterinary medicine. Although not classified as a medical condition, burnout can affect sleep patterns and contributes to chronic low grade systemic inflammation, autonomic imbalance, hormonal imbalances and immunodeficiencies, thereby increasing the risks of physical and psychological ill health in affected individuals. Cultural misconceptions in the profession often lead to perceptions of burnout as a personal failure, ideas that healthcare professionals are somehow at lower risk for suffering, and beliefs that affected individuals can or should somehow heal themselves. However, these concepts are antiquated, harmful and incorrect, preventing the design of appropriate solutions for this serious and growing challenge to the veterinary profession. Veterinarians must first correctly identify the nature of the problem and understand its causes and impacts before rational solutions can be implemented. In this first part of two companion reviews, burnout will be defined, pathophysiology discussed, and healthcare and veterinary-relevant occupational stressors that lead to burnout identified.

Intraoperative workload in elective open vascular and endovascular surgery: A study of procedural drivers

This study investigated vascular surgeon workload and its association with specific procedural drivers over different procedure types. Thirteen attending vascular surgeons (two females) were emailed a survey over a 3-month period. Data from 253 surgical procedures (118 open, 85 endovascular, 18 hybrid, and 32 venous) revealed high physical and cognitive workload among vascular surgeons. Based on the statistically significant findings and similar non-significant trends in the data (significance level of 0.01), open and hybrid vascular procedures showed higher levels of physical and cognitive workload compared to venous cases, while endovascular procedures were relatively more moderate. Additionally, the workload subscales for five subcategories of open procedures (e.g., arteriovenous access) as well as three subcategories of endovascular procedures (e.g., aortic) were compared. The granularity of the intraoperative workload drivers across various vascular procedure types and adjunct equipment could be the key to create targeted ergonomic interventions to reduce workload during vascular surgeries.

Psychological Stress and Hand Eczema in Physicians and Dentists: A Comparison Based on Surgical Work

BACKGROUND

This research looks at the connection between psychological stress and the prevalence of hand eczema (HE) among physicians and dentists (surgeons, non-surgeons).

METHODS

This cross-sectional field study involved 185 participants: physicians (surgeons, non-surgeons), dentists (surgeons, non-surgeons) and controls. Hand lesions were examined using the Osnabrueck Hand Eczema Severity Index (OHSI), and participants answered the Nordic Occupational Skin Questionnaire (NOSQ) and Perceived Stress Scale (PSS). Patch tests were performed using commercial contact allergens.

RESULTS

The estimated prevalence of HE (self-reported) was 43.9% (physicians 44.6%; dentists 43.2%). HE was significantly more reported by surgeons than controls (p < 0.004; V = 0.288). Degrees of perceived stress (PSS) did not differ significantly between the groups, though physicians non-surgeons most exhibited high stress (50%), and physicians surgeons most exhibited low stress (22.5%). High stress was associated with 2.5 higher odds for self-reported HE (p = 0.008). Low stress was greater among physicians/dentists who did not report eczema (41.0% vs. 24.6%); moderate stress was more common among those who reported eczema (72.3% vs. 51.8%; p = 0.038; V = 0.210).

CONCLUSIONS

Since high stress levels may negatively influence physicians'/dentists' work and quality of life, measures to decrease stress could be introduced into the treatment of healthcare workers who are prone to it.

StemRad MD, An Exoskeleton-Based Radiation Protection System, Reduces Ergonomic Posture Risk Based on a Prospective Observational Study

OBJECTIVE

Poor ergonomic posture during interventional procedures might lead to increased physical discomfort and work-related musculoskeletal disorders. Adjunctive equipment such as lead aprons (LAs) has been shown to increase ergonomic posture risk (EPR). The objective of this study was to evaluate the effectiveness of StemRad MD (StemRad Ltd., Tel Aviv, Israel), a weightless exoskeleton-based radiation protective ensemble, in reducing EPR on the operator using wearable inertial measurement unit (IMU) sensors.

METHODS

A prospective, observational study was conducted at an academic hospital. Inertial measurement unit sensors were affixed to the upper back of 9 interventionalists to assess ergonomic risk posture during endovascular procedures while wearing a traditional LA or the StemRad MD radiation protection system. Total fluoroscopy time, procedure type, and ergonomic risk postures were recorded and analyzed.

RESULTS

Twenty-one cases were performed with StemRad MD and 30 with LAs. Mean procedure time for the StemRad MD procedures was 48.4±23.3 minutes (range: 24-106 min), and for LA procedures, it was 34.66±25.83 minutes (range: 6-100 min) (p=.060). The operators assumed low-risk ergonomic positions in 96.1% of StemRad MD cases and in 62.9% of LA cases (p=.001), and high-risk ergonomic positions in 0% and 6.2%, respectively (p=.80). Mean EPR score for StemRad MD was 1.16, and for the LA, it was 1.49 (p=.001).

CONCLUSIONS

StemRad MD significantly reduces the EPR to the torso compared with a LA-based radiation protection system.

CLINICAL IMPACT

Poor ergonomic posture during interventional procedures might leas to work-related musculoskeletal disorders for healthcare workers. StemRad MD, a weightless, exoskeleton-based radiation protection system was shown to significantly reduce ergonomic posture risk to the torso compared to conventional lead aprons. This might lead to reduced physical discomfort for procedure-based specialists.

Ergonomics in Otolaryngology: A Systematic Review and Meta-analysis

OBJECTIVES

To determine the proportion of otolaryngologists with work-related musculoskeletal discomfort (WRMD) and to review objective ergonomic data that contribute to WRMD.

STUDY DESIGN

Systematic review and meta-analysis.

METHODS

A comprehensive search of the literature identified 1121 articles for initial review of which 19 (3563 participants) met criteria for qualitative discussion and eight (2192 participants) met criteria for meta-analysis. Random effects meta-analyses were used to estimate the proportion of otolaryngologists reporting WRMD.

RESULTS

The overall proportion (95% confidence intervals [CI]) of general otolaryngologists reporting WRMD was 0.79 (0.66, 0.88) for any symptoms; 0.54 (0.40, 0.67) for neck symptoms; 0.33 (0.20, 0.49) for shoulder symptoms; and 0.49 (0.40, 0.59) for back symptoms. Surgeons performing primarily subspecialty cases had a lower estimated overall prevalence of WRMD versus those performing general ENT cases, however the odds ratio (OR) was not statistically significant (OR [95% confidence interval] 0.53 [0.22, 1.25]). 23%-84% of otolaryngologists underwent medical treatment for WRMD. 5%-23% took time off work and 1%-6% stopped operating completely as a result of WRMD. 23%-62.5% of otolaryngologists believed WRMD negatively impacted their quality of life. Objective measures of ergonomic posture indicate moderate to severe risk of injury during the routine clinic and surgical procedures with none found to be low risk.

CONCLUSIONS

Ergonomic stressors among otolaryngologists contribute to a high rate of WRMD across all subspecialties with notable impact on productivity, longevity, and quality of life. Laryngoscope, 133:467-475, 2023.

Comprehensive Assessment of Burnout Among Surgical Trainees and Practicing Surgeons: A Systematic Review

OBJECTIVE

Surgeon burnout has received increasing attention due to evidence of high prevalence across specialties. We aimed to (1) systematically characterize existing definitions of burnout, (2) evaluate tools to measure burnout, and (3) determine risk factors of surgical burnout.

DESIGN

PubMed, Google Scholar, and Embase databases were searched to identify burnout rates and tools used to measure the quality of life (QoL) published from January 2000-December 2021.

PARTICIPANTS

Surgical Trainees and Practicing Surgeons.

RESULTS

We identified 39 studies that defined surgical burnout, with 9 separate tools used to measure QoL. Surgeon burnout rates were found to be highest among general surgery trainees (20%-95%). Burnout among general surgery attendings ranged from 25% to 44%. Those most likely to experience burnout were younger and female. High rates of surgeon burnout were reported among all surgical specialties; however, these rates were lower than those of general surgeons.

CONCLUSION

Definitions of burnout vary throughout the surgical literature, but are consistently characterized by emotional exhaustion, depersonalization, and lack of personal accomplishment. The most utilized tool to measure surgical burnout has been the Maslach Burnout Inventory. Across specialties, there are high rates of burnout in both surgical trainees and attendings, indicating that this is a systemic issue within the field of surgery. Given the wide-scale nature of the problem, it is recommended that institutions provide support to surgical trainees and attending surgeons and that individual surgeons take steps toward mitigating burnout.

Effects of passive exoskeleton support on EMG measures of the neck, shoulder and trunk muscles while holding simulated surgical postures and performing a simulated surgical procedure

Exoskeletons have shown significant impact at reducing the biomechanical demand on muscles during repetitive lifting and overhead tasks in non-healthcare industries. However, the benefits of exoskeletons are yet to be realized in the operating room, particularly as work-related musculoskeletal disorders continue to be a concern for surgeons. This study quantified the effect of using neck, arm, and trunk exoskeletons on muscle activity while assuming typical postures held in the operating room. Fourteen participants were recruited to participate in this study. In this two-part experiment participants were asked to 1) hold a series of neck flexion, arm abduction and trunk flexion postures seen in surgical procedures, and 2) perform a simulated surgical task requiring five different trunk flexion posture levels. Participants were required to complete these tasks with and without passive exoskeleton(s). This study showed that even for postures held short time periods, exoskeletons are beneficial at reducing the demand on muscles; however, the reduction in muscle demand depends on body segment and postural angle, as intended with these passive exoskeletons. Furthermore, for the simulated surgical task with awkward trunk flexion postures (10-65°), the trunk exoskeletons showed a significant reduction in the rate of rise in back muscle sEMG (+1.365%MVC/min vs. +0.769%MVC/min for non-dominant lumbar extensor muscles, p = 0.0108; +1.377%MVC/min vs. +0.770%MVC/min for the dominant lumbar extensor muscles, p = 0.0196) over 25 min, consequently resulting in improved trunk subjective discomfort scores (7.34 vs. 4.30, p < 0.05), with no impact on the neck and shoulder biomechanical demand. The results from this study indicate that exoskeletons may be a potential intervention to reduce biomechanical loading during surgery.

Prevalence and risk factors for burnout in U.S. vascular surgery trainees

OBJECTIVE

Burnout and suicidality are known risks for vascular surgeons above other surgical subspecialties, with surgical trainees at risk for exposure to factors that increase burnout. This study aimed to inform initiatives to improve wellness by assessing the prevalence of hazards in vascular training (mistreatment, duty-hour violations) and the rates of wellness outcomes (burnout, thoughts of attrition/specialty change/suicide). We hypothesized that mistreatment and duty-hour violations would predispose trainees to increased burnout.

METHODS

We performed a cross-sectional study of residents and fellows enrolled in accredited United States vascular surgery training programs using a voluntary, confidential survey administered during the 2020 Vascular Surgery In-Training Examination. The primary outcome assessed was burnout symptoms reported on a weekly basis or more frequently. The rates of wellness outcomes were measured. The association of mistreatment and duty hours with the primary outcome was modeled with multivariable logistic regression.

RESULTS

A total of 475 residents and fellows who were enrolled in one of 120 vascular surgery training programs completed the survey (84.2% response rate). Of 408 trainees completing burnout survey items, 182 (44.6%) reported symptoms of burnout. Fewer trainees reported thoughts of attrition (n = 42 [10.0%], specialty change (n = 35 [8.4%]), or suicide (n = 22 [4.9%]). Mistreatment was reported by 191 vascular trainees (47.3%) and was more common in female trainees (n = 63 [48.5%] reporting monthly or more frequently) compared with male trainees (n = 51 [18.6%]; P < .001). Duty-hour violations were also more commonly reported by female trainees (n = 31 [21.4%] reporting 3+ months in violation) compared with male trainees (n = 50 [16.2%]; P = .002). After controlling for race/ethnicity, postgraduate year, program type, and geography, female trainees were less likely to report burnout (odds ratio [OR], 0.49; 95% confidence interval [CI], 0.28-0.86). Trainees experiencing mistreatment monthly or more were three times more likely to report burnout (OR, 3.09; 95% CI, 1.78-5.39). Frequency of duty-hour violations also increased the odds of reporting burnout (1-2 months in violation: OR, 2.09; 95% CI, 1.17-3.73; 3+ months in violation: OR, 3.95; 95% CI, 2.24-6.97).

CONCLUSIONS

Nearly one-half of vascular surgery trainees reported symptoms of burnout, which was associated with frequency of mistreatment and duty-hour violations. Interventions to improve well-being in vascular surgery must be tailored to the local training environment to address trainee experiences that contribute to burnout.

Evaluating the physical, psychosocial and ergonomic burden of lead aprons among Jordanian interventionists: a nationwide study

Objectives. This study assessed the physical and psychological burden of lead apron use on Jordanian interventionists and investigated the attitudes and knowledge of interventional personnel toward ergonomic guidelines and practices. Methods. A cross-sectional investigation of a randomly sampled Jordanian cohort of interventional personnel was conducted using a self-administered questionnaire.

Results. A nationwide sample of 130 practitioners with a mean 9.3 ± 8.1 years of experience in interventional procedures participated. Practitioners were aware of their apron's weight but not of its lead equivalence (71.5%). More than 60% of respondents complained of back pain. While 66.9% did not develop musculoskeletal pathologies, 64.3% of those with already established musculoskeletal pathologies experienced worse pain due to apron usage. Despite believing in the effect of lead aprons on muscular strain and work performance, 78.5% adhere to its usage. In terms of ergonomics, only 39.2% were aware of ergonomic guidelines; however, 90.0% believe that ergonomic practices are essential as 49.2% have experienced discomfort due to bad ergonomics. In terms of psychological burden, anxiety and depression were suggested in 16.4 and 21.6% of the sample.

Conclusion. Jordanian interventionists portray positive attitudes toward lead aprons; nevertheless, their awareness of ergonomic practices warrants the implementation of evidenced-based interventions.

Endocrine surgeons have high rates of work-related musculoskeletal (MSK) injury and symptoms

BACKGROUND

Work-related injury and musculoskeletal (MSK) symptoms are common among surgeons, however data for endocrine surgeons (ES) are lacking.

METHODS

A survey was distributed to American Association of Endocrine Surgeons (AAES) and Endocrine section of American Head and Neck Society (AHNS) members.

RESULTS

MSK symptoms were present in 199 (90%) of 220 respondents, most notably pain (91%) and stiffness (81%). The most common locations were neck (87%) and shoulders (55%). Women were more likely to be symptomatic (98.6% versus 86.4%, p = 0.004). Although 67% of respondents reported awareness of ergonomic principles, only 19% had learned about them during training. The most common ergonomic adjustments were stretching, use of microbreaks and headlight/loupe adjustments.

CONCLUSION

The vast majority of ES surgeons suffer MSK symptoms that could potentially impact their quality of life and career length. Effective strategies are needed to protect this highly trained workforce.

Ergonomics and Work-Related Musculoskeletal Disorders: Characteristics Among Female Interventionists

Interventional radiology is a procedural specialty that performs minimally invasive operations under image guidance. Currently, there are inadequate ergonomic protocols for work-related musculoskeletal disorder (WMSD) prevention in interventional radiology (IR), and there is a paucity of information discerning gender differences in WMSDs. This article reviews current literature that addresses WMSDs in female physicians practicing interventional and fluoroscopic procedures, including interventional radiology, interventional cardiology, electrophysiology, vascular surgery, orthopedic surgery, neurosurgery, and gastroenterology. We searched PubMed and EBSCOhost databases for ergonomic studies that reported female physician WMSDs in the specialties listed above. After a thorough evaluation for inclusion based on eligibility criteria, 11 studies were included. From this search, there was poor female representation, averaging 25.7% of respondents. Several characteristics identified across the studies were that women were generally shorter, wore smaller glove sizes, and were younger than their male colleagues. Seventy-two percent of female proceduralists reported WMSDs versus 46.6% of their male colleagues. Additionally, women may experience more upper extremity pain than lumbar pain, which men commonly reported. Potential contributing factors to WMSDs are the size and design of procedural tools and the possible predisposition of female physicians to experience upper extremity WMSDs while performing the same operations as men. As more women enter medicine and pursue careers in procedural fields like interventional radiology, it is essential to address these discrepancies and develop ergonomically sound solutions for women.

Survey of Canadian vascular surgeons and trainees finds work-related musculoskeletal pain and discomfort is common

BACKGROUND

Occupational injuries and disability are a source of surgeon morbidity. The purpose of this study was to assess the physical toll of working in operating rooms by Canadian vascular surgeons.

OBJECTIVE

To assess work-place musculoskeletal (MSK) complaints and challenges faced by Canadian vascular surgeons and trainees and its implications on surgical practice and occupational longevity.

METHODS

An online survey was distributed to resident and surgeon members of the Canadian Society of Vascular Surgery. The survey collected data on demographics, operative volume, and work-related MSK symptoms.

RESULTS

The survey was distributed to 188 surgeons and trainees. After three e-mailings, 109 surveys were returned (58% response rate). Of the responders, 87% were male, 51% were 45 years or older, and 56% had been in practice for ten or more years. Workplace MSK symptoms was reported by 83% of the responders. The most common locations were the low back (78%), neck (74%), and shoulder (30%). Most responders (83%) believed that these symptoms were related to their operative environment. Almost half (48%) sought medical care. As a result of these MSK symptoms, 25% experience chronic pain with 8% reporting time off work as a consequence. Another 11% reported an impact on their operative performance with 14% considering early retirement. A lack of operating room system changes to prevent workplace injury and disability was noted by 85% of the responders although only 3% reported their disability to their department.

CONCLUSION

Occupational MSK symptoms and disability is common amongst Canadian vascular surgeons. Further research is needed to create programs to improve surgeon morbidity.

A Gender-Based Analysis of Predictors and Sequelae of Burnout Amongst Practicing American Vascular Surgeons

OBJECTIVE

Surgeons report higher burnout and suicidal ideation (SI) rates than the general population. This study sought to identify the prevalence and gender-specific risk factors for burnout and SI among men and women vascular surgeons to guide future interventions.

METHODS

In 2018, active Society for Vascular Surgery (SVS) members were surveyed confidentially using the Maslach Burnout Index embedded in a questionnaire that captured demographic and practice-related characteristics. Results were stratified by gender. Univariate and multivariate logistic regression models were developed to identify predictors for the end points of burnout and SI.

RESULTS

Overall survey response rate was 34.3% (N=878) of practicing vascular surgeons. A higher percentage of women responded (19%) than compose SVS membership (13.7%). Women respondents were significantly younger, with fewer years in practice, and were less likely to be in private practice than the men who responded. Women were also less likely to be married/partnered, or to have children. The prevalence of burnout was similar for women and men (42.3% and 40.9% [NS]); however, the prevalence of SI was significantly higher in women (12.9% vs 6.6%; P < .007). Whereas there was no difference in mean hours worked or call taken, women were more likely to have had a recent conflict between work and home responsibilities and to have resolved this conflict in favor of work. Although men and women had the same incidence of reported recent medical errors, women were less likely to self-report a recent malpractice suit or to think that a fair resolution was reached. There was no gender difference in reported work-related pain. Multivariable analysis revealed that not enough family time and work-related pain were predictors for burnout in both men and women. Additional factors were associated with burnout in men, such as malpractice and EMR dissatisfaction. Multivariable analysis revealed that work-related pain was an independent predictor for SI for the entire cohort.

CONCLUSION

The prevalence of burnout among vascular surgeons is high. Women vascular surgeons have double the rates of SI compared to male vascular surgeons. Taken together, this study demonstrated that many of the same factors are associated with burnout in women and men, which include not enough family time, conflict between work and personal life, and work-related pain. Additional factors in men included conflict between work and family, work-related pain, and EMR dissatisfaction.

Reimagining the IR Workflow for a Better Work-Life Balance

Several workflow changes were implemented in a large academic interventional radiology practice, including separation of inpatient and outpatient services, early start times, and using an adaptive learning system to predict case length tailored to individual physicians. Metrics including procedural volume, on-time start, accuracy at predicting case length, and room shutdown time were assessed before and after the intervention. Considerable improvements were seen in accuracy of first case start times, predicting block times, and last case encounter ending times. It is proposed that with improved role clarity, interventional radiologists can regain control over their schedules, utilize work hours more efficiently, and improve work-life balance.

Factors associated with burnout amongst medical students, residents, and attendings in Orthopaedics

Background

Methods

Results

Conclusion

Malpractice Allegations Against Vascular Surgeons:Prevalence, Risk Factors, and Impact on Surgeon Wellness

OBJECTIVES

The contemporary medicolegal environment has been linked to procedure overuse, healthcare variation, and higher costs. For physicians accused of malpractice, there is also a personal toll. The objective of this study was to evaluate the prevalence of and risk factors for involvement in medical malpractice lawsuits among US vascular surgeons, and to examine the association between these allegations with surgeon wellness.

METHODS

In 2018, the Society of Vascular Surgery (SVS) Wellness Task Force conducted a confidential survey of active members using a validated burnout assessment (Maslach Burnout Index) embedded into a questionnaire. This survey included questions related to medical errors and malpractice litigation. De-identified demographic, personal, and practice-related characteristics were assessed in respondents who reported malpractice allegations in the preceding two years, then compared to those without recent medicolegal litigation. Risk factors for malpractice allegations were identified (chi-square, Kruskal-Wallis tests), and the association between malpractice allegations with wellness was examined. Multivariate logistic regression models were developed to identify independent risk factors for malpractice accusations.

RESULTS

Of 2905 active SVS members, 871 responses from practicing vascular surgeons were analyzed. 161 (18.5%) were named in a malpractice lawsuit within two years. Malpractice allegations were significantly associated with surgeon burnout [OR 1.47 (1.01, 2.15), p=0.041], but not with self-reported depression or suicidal ideation. The nature of malpractice claims included procedural errors (23.1%), failure to treat (18.8%) and error/delay in diagnosis (16.9%). 20% of claims were settled prior to trial and 19% were dismissed. Defendant vascular surgeons reported a "fair" resolution in 26.4% of closed cases. By unadjusted analysis, factors significantly associated with recent malpractice claims included mean age (51.7+/-10.0 vs. 49.3+/-11.2; p=0.0044) and mean years in practice (18.0+/-10.7 vs. 15.2+/-11.8; p=0.0007). Multivariate analysis revealed independent variables associated with malpractice allegations, including on-call frequency (p=0.0178), recent medical errors (p=0.0189), and male surgeons (p=0.045).

CONCLUSIONS

Malpractice allegations are common for vascular surgeons and are significantly associated with surgeon burnout. Nearly 20% of survey respondents reported being named in a lawsuit within the preceding two years. Our findings underscore the need for SVS initiatives to provide counseling and peer support for vascular surgeons facing litigation.

Ergonomics in Interventional Radiology: Awareness Is Mandatory

Ergonomics in interventional radiology has not been thoroughly evaluated. Like any operators, interventional radiologists are exposed to the risk of work-related musculoskeletal disorders. The use of lead shielding to radiation exposure and the lack of ergonomic principles developed so far contribute to these disorders, which may potentially affect their livelihoods, quality of life, and productivity. The objectives of this review were to describe the different situations encountered in interventional radiology and to compile the strategies both available to date and in development to improve ergonomics.

Importance of Work-Related Psychosocial Factors in Exertion Perception Using the Borg Scale Among Workers Subjected to Heavy Physical Work

Objective: This study aimed to analyse the role of several environmental and time variables, as well as individual and psychosocial factors, on the perception of exertion, expressed by using the Borg scale, on logistics workers performing heavy manual tasks. Materials and Methods: We enrolled 56 subjects working in logistics sector that were interviewed on the perceived exertion required to execute a task of manual lifting of heavy loads, by using the Borg scale. The interviews were carried out during different shifts, at different times during the shifts and during several different months of the year. We also assessed the workers' anthropometric characteristics, length of service, any musculoskeletal diseases, and physical activity outside work. Workers were also interviewed using the structured OREGE questionnaire, in order to evaluate the main symptoms of stress and work-related psychosocial risk factors. Results: Overall, the subjective perception of the strength exerted by the workers exposed to a high risk of manual handling of loads was moderate. The rating attributed using the Borg scale showed no correlation with any of the investigated variables. 100% of the workers denied to suffer from symptoms of stress, whereas in terms of psychosocial factors, the workload was globally perceived as positive. Conclusion: The study results support the hypothesis that optimal work conditions-from a psychosocial point of view-reduce the subjective perception of exertion by workers even if exposed to a high risk of biomechanical overload.

Effects of break scheduling strategies on subjective and objective measures of neck and shoulder muscle fatigue in asymptomatic adults performing a standing task requiring static neck flexion

Sustained non-neutral postures of the head/neck are related to transient neck discomfort and longer-term disorders of the neck. Periodic breaks can help but the ideal length and frequency of breaks are yet to be determined. The current study aimed to quantify the effects of three work-rest strategies on fatigue development. Participants maintained a 45-degree neck flexion posture for a total of 60 min and were provided 3 min of rest distributed in different ways throughout the experiment [LONG (one, 3-min break), MEDIUM (two, 1.5-min breaks), or SHORT (five, 36-s breaks)]. Surface electromyography data were collected from the bilateral neck extensors and trapezius. Subjective discomfort/fatigue ratings were also gathered. Results of the analysis of the EMG data revealed that the SHORT condition did not show increased EMG activity, while LONG [21%] and MEDIUM [10%] did (p < 0.05), providing objective data supporting the guidance of short, frequent breaks to alleviate fatigue.

Intraoperative posture and workload assessment in vascular surgery

Quantifying the workload and postural demand on vascular surgeons provides valuable information on the physical and cognitive factors that predispose vascular surgeons to musculoskeletal pain and disorders. The aim of this study was to quantify the postural demand, workload, and discomfort experienced by vascular surgeons and to identify procedural factors that influence surgical workload. Both objective (wearable posture sensors) and subjective (surveys) assessment tools were used to evaluate intraoperative workload during 47 vascular surgery procedures. Results demonstrate unfavorable neck and low back postures as well as high pain scores for those body segments. Additionally, workload from subjective surveys increased significantly as a function of operative duration, and mental workload was high across all procedure types. Neck postural risk exposure and physical demand were among the variables that increased with surgical duration, procedure type, and loupes used by the surgeons. Correlations among postural angles and pain scores showed consistency between the objective assessment and the subjective surveys for neck and trunk. The authors believe that the results of this study highlight the need for developing mitigating measures such as ergonomic interventions for vascular surgery.

Factors Influencing Job Burnout and Musculoskeletal Disorders among Coal Miners in the Xinjiang Uygur Autonomous Region

Background

Work-related musculoskeletal diseases (WMSDs) have been associated with job burnout. Currently, few studies have investigated the relationship between job burnout and WMSDs among coal miners.

Methods

In this cross-sectional study, 1,325 staff were selected from 6 coal mining companies using a stratified cluster sampling method. The Chinese version of "Musculoskeletal Questionnaire" and "Occupational Burnout Scale" were used to investigate the link between WMSDs and job burnout. Logistic regression was conducted to analyze the factors influencing WMSDs.

Results

A total of 1,500 questionnaires were distributed, with a response rate of 88.33%. The prevalence of WMSDs in coal miners was 65.58%, while the prevalence of total, mild, moderate, and severe burnout were 90%, 39.77%, 43.77%, and 6.49%, respectively. The average score for job burnout was 50.78 ± 11.93. The prevalence of WMSDs among coal miners varied significantly with the length of service (χ ²=14.493, P=0.001), type of work (χ ²=11.438, P=0.022), shift system (χ ²=6.462, P=0.040), and annual income (χ ²=6.315, P=0.043). The proportions of male coal miners with moderate and severe burnout were 45.1% and 6.8%, respectively, which were higher compared with 28.6% and 2.9%, respectively, for women. The proportion of male coal miners with mild burnout was 38.1%, which was lower compared with 59.0% for women (P < 0.05). Coal miners who work more than two shifts had the highest burnout, while those who work day shifts had the lowest burnout (P < 0.001). The prevalence of WMSDs in the severe burnout group and in 9 body locations was significantly higher than that in other burnout groups (P < 0.001). Logistic regression results showed that length of service, type of work, annual income, and burnout level are associated with WMSDs among coal miners (P < 0.05).

Conclusions

The prevalence of job burnout and WMSDs among coal miners in Xinjiang is relatively high. Job burnout is a risk factor for WMSDs among coal miners.

Ergonomics in IR

Ergonomic research in the field of interventional radiology remains limited. Existing literature suggests that operators are at increased risk for work-related musculoskeletal disorders related to the use of lead garments and incomplete knowledge of ergonomic principles. Data from existing surgical literature suggest that musculoskeletal disorders may contribute to physician burnout and female operators are at a higher risk of developing musculoskeletal disorders. This review article aims to summarize the existing ergonomic challenges faced by interventional radiologists, reiterate existing solutions to these challenges, and highlight the need for further ergonomic research in multiple areas, including burnout and gender.

Vascular surgeon wellness and burnout: A report from the Society for Vascular Surgery Wellness Task Force

INTRODUCTION

Physician burnout has been linked to medical errors, decreased patient satisfaction, and decreased career longevity. In light of the increasing prevalence of cardiovascular disease, vascular surgeon burnout presents a legitimate public health concern owing to the impact on the adequacy of the vascular surgery workforce. The aims of this study were to define the prevalence of burnout among practicing vascular surgeons and identify factors that contribute to burnout to facilitate future Society for Vascular Surgery (SVS) initiatives to mitigate this crisis.

METHODS

In 2018, active SVS members were surveyed electronically and confidentially using the Maslach Burnout Inventory. The survey was tailored to explore specialty-specific issues, and to capture demographic and practice-related characteristics. Emotional exhaustion (EE) and depersonalization (DP) were analyzed as dimensions of burnout. Consistent with convention, surgeons with a high score on the DP and/or EE subscales of the Maslach Burnout Inventory were considered to have at least one manifestation of professional burnout. Risk factors associated with symptoms of burnout were identified using bivariate analyses (χ², Kruskal-Wallis). Multivariate logistic regression models were developed to identify independent risk factors for burnout.

RESULTS

Of 2905 active SVS members, 960 responded to the survey (34% participation rate). After excluding retired surgeons and incomplete submissions, responses from 872 practicing vascular surgeons were analyzed. The mean age was 49.7 ± 11.0 years; the majority of respondents (81%) were male. Primary practice settings were academic (40%), community practice (41%), veteran's hospital (3.3%), active military practice (1.5%), or other. Years in practice averaged 15.7 ± 11.7. Overall, 41% of respondents had at least one symptoms of burnout (ie, high EE and/or high DP), 37% endorsed symptoms of depression in the past month, and 8% indicated they had considered suicide in the last 12 months. In unadjusted analysis, factors significantly associated with burnout (P < .05) included clinical work hours, on-call frequency, electronic medical record and documentation requirements, work-home conflict, and work-related physical pain. On multivariate analysis, age, work-related physical pain and work-home conflict were independent predictors for burnout.

CONCLUSIONS

Symptoms of burnout and depression are common among vascular surgeons. Advancing age, work-related physical pain, and work-home conflict are independent predictors for burnout among vascular surgeons. Efforts to promote vascular surgeon well-being must address specialty-specific challenges, including the high prevalence of work-home conflict and occupational factors that contribute to work-related pain.

Intraoperative musculoskeletal discomfort and risk for surgeons during open and laparoscopic surgery

BACKGROUND

Surgeon workload is significant both mentally and physically and may differ by procedure type. When comparing laparoscopic surgery and open surgery, studies have reported contrasting results on the physical and mental workload assessed.

METHODS

Wearable posture sensors and pre-/post-surgical questionnaires were employed to assess intraoperative workload and to identify risk factors for surgeons using objective and subjective measures.

RESULTS

Data from 49 cases (27 open and 22 laparoscopic surgeries performed by 13 male and 11 female surgeons) were assessed. More than half the surgeons reported a clinically relevant post-surgical fatigue score. The surgeons also self-reported a significant increase in pain for the neck, upper back, and lower back during/after surgery. Procedural time had significant impacts on fatigue, body part pain, and subjective (NASA-TLX) workload. The objectively assessed intraoperative work postures using wearable sensors showed a high musculoskeletal risk for neck and lower back based on their posture overall. Open surgeries had significantly larger neck angles (median [IQR]: 40 [28-47]°) compared with laparoscopic surgeries (median [IQR]: 23 [16-29]°), p < 0.001) and torso (median [IQR]: 17 [14-22]° vs. 13 [10-17]°, p = 0.006).

CONCLUSION

Surgeons reported significantly higher levels of fatigue and pain in the neck and lower back during or after performing a surgical case. Longer procedural time resulted in more self-rated fatigue, pain, and subjective workload. Open surgery had higher postural risk. Overall, surgeons spent a disturbingly high percentage of time during surgery in high-risk musculoskeletal postures, especially the neck. These results show that intraoperative postural risk is very high and that interventions are necessary to protect surgeon musculoskeletal health for optimal surgeon performance and career longevity.

Physical pain and musculoskeletal discomfort in vascular surgeons

OBJECTIVE

Work-related pain and disability have been reported in the literature among surgeons. This national survey was designed to identify the prevalence and severity of these symptoms in vascular surgeons.

METHODS

A survey was emailed to the 2910 members of the Society for Vascular Surgery. Physical pain was evaluated based on body part, and type of vascular procedure performed using the Borg 0 to 10 pain scale. Wellness questions were also queried.

RESULTS

A total of 775 of Society for Vascular Surgery members responded, with a 26.6% response rate. Retirees were excluded from the study (n = 39). Among those actively working (n = 736), surgeons have been practicing surgery, on average, for 17.2 ± 11.6 years, with a mean age of 51.4 ± 10.9 years, and 83.6% are male. After a full day of open surgery, the majority of the responding vascular surgeons are in a moderately strong amount of pain (mean score, 4.4 ± 2.3). After a full day of endovascular procedures, most vascular surgeons are in a moderately strong amount of pain (mean score, 3.9 ± 2.4). Pain after open surgery is greatest in the neck, and after endovascular surgery pain is highest in the lower back. Surgeons performing endovenous procedures demonstrated the lowest pain scores (2.0 ± 2.0). In total, 36.9% (242/655, 81 missing responses) have sought medical care for work-related pain, with 8.3% (61/736) taking time away from the operating room. Of those, 26.2% (193/736) report pain severe enough that it interferes with sleep. Seventy-two (10%) required surgery or other significant medical procedures. Of the 39 retirees, 26% ended their careers owing to physical disabilities from work-related pain. Out of the entire cohort, 52.7% (334/633,103 missing responses) feel that physical discomfort will affect the longevity of their careers. Additionally, we found that high work-related physical discomfort is significantly associated with burnout (burnout vs no burnout; P < .0001).

CONCLUSIONS

Our study shows that the majority of practicing vascular surgeons responding to the survey are in pain after a day of operating. Addressing work-related pain serves to improve the lives and careers of vascular surgeons and enhance surgical longevity.

Practice Longer and Stronger: Maximizing the Physical Well-Being of Surgical Residents with Targeted Ergonomics Training

OBJECTIVE

Pain and disability among surgeons can lead to practice restrictions, early retirement, and physician burnout. This project sought to address the physical well-being of surgical residents by teaching ergonomic principles, a "microbreaks" model, and stretching exercises aimed at targeting the four anatomical areas identified as most problematic for surgeons.

DESIGN

Three modules, led by physical therapists, were presented to surgical residents over the course of the 2018-2019 academic year. These modules targeted specific problem areas for surgeons according to current literature. A perioperative micro-break model was also presented. Pre- and post-lecture surveys were administered to document pain, applicability of lecture content and effectiveness for use in the operating room (OR), and were reviewed retrospectively.

SETTING

Jackson Memorial Hospital, DeWitt Daughtry Family Department of Surgery, Division of General Surgery, Miami, Florida RESULTS: A large number of participants reported pain in one or more body part (87%) prior to beginning this ergonomic training and 39% indicated that this pain was performance-limiting. The majority of residents (93%) who attended Module #3 reported that learning the targeted exercises and microbreaks model would help them physically perform better in the OR and, in fact, after practicing these exercises during this Module, 85% of residents reported decreased pain, especially in the areas of the cervical and lumbar spine.

CONCLUSIONS

Preliminary data indicate that this novel curriculum was perceived as valuable by surgical residents and that practicing these targeted exercises reduced pain, particularly in the neck and lower back. Further research is needed to determine the longitudinal effects of this ergonomics curriculum on surgical resident well-being and whether these exercises will be effective in reducing pain and enhancing performance in the OR setting.

Intraprocedural ergonomics of vascular surgeons

OBJECTIVE

The objective of this study was to estimate the ergonomic postural risk (EPR) for musculoskeletal posture of vascular surgeons performing open and endovascular procedure types and with various adjunctive equipment using wearable inertial measurement unit (IMU) sensors. The hypothesis was that EPR will increase with increased physical and mental demand as well as with procedural complexity.

METHODS

A prospective, observational study was conducted at a large, quaternary academic hospital located at two sites. Sixteen vascular surgeons (13 male) participated in the study. Participants completed a presurgery and postsurgery survey consisting of a body part discomfort scale and a modified NASA-Task Load Index. Participants wore IMU sensors on the head and upper body to measure EPR during open and endovascular procedures.

RESULTS

Vascular surgeons have increased EPR scores of the neck as measured by the IMUs and increased lower back pain when performing open surgery compared with non-open surgery (P < .05). Open procedures were rated as more physically demanding. The use of loupes resulted in increased EPR scores for the neck and torso (P < .05), and they were significantly associated with higher levels of lower back pain during procedures (P < .05) as well as with higher levels of physical demand (P < .05). The use of headlights also resulted in increased subjectively measured levels of physical demand and lower back pain. In comparing survey responses with IMU data, surveyed physical demand was strongly and significantly correlated with the neck (r = 0.61; P < .0001) and torso (r = 0.59; P < .0001) EPR scores. The use of lead aprons did not affect EPR or most surveyed measures of workload but resulted in significantly higher levels of distraction (P < .01). The data presented highlight the potential of using wearable sensors to measure the EPR of surgeons during vascular surgical procedures.

CONCLUSIONS

Vascular surgeons should be aware of EPR during the performance of their duties. Procedure type and surgical adjuncts can alter EPR significantly.

Effect of surgical radiation personal protective equipment on EMG-based measures of back and shoulder muscle fatigue: A laboratory study of novices

Interventional radiologists are at increased risk for musculoskeletal discomfort/disorders and this has been linked to the use of radiation personal protective equipment (rPPE). This study examined the effects of rPPE on the development of fatigue of the erector spinae and trapezius muscles. Surface electromyography (EMG) was used to capture muscle activity, and both time domain (average rectified value) and frequency domain (median frequency) measures were considered in the assessment of localized muscle fatigue. Sixteen participants performed a simulated surgical procedure requiring intermittent 30° flexed static trunk posture with and without rPPE on separate days. The results showed that the rPPE condition demonstrated significantly greater (p < 0.05) downward shift in median frequency in the left lumbar erector spinae and left lower thoracic erector spinae consistent with task-induced localized muscle fatigue. Ergonomic intervention strategies are discussed.

Impact of Procedure Type, Case Duration, and Adjunctive Equipment on Surgeon Intraoperative Musculoskeletal Discomfort

BACKGROUND

Surgeons are at high risk of developing musculoskeletal disorders.

STUDY DESIGN

This study was designed to identify risk factors and assess intraoperative physical stressors using subjective and objective measures, including type of procedure and equipment used. Wearable sensors and pre- and postoperation surveys were analyzed.

RESULTS

Data from 116 cases (34 male and 19 female surgeons) were collected across surgical specialties. Surgeons reported increased pain in the neck, upper, and lower back both during and after operations. High-stress intraoperative postures were also revealed by the real-time measurement in the neck and back. Surgical duration also impacted physical pain and fatigue. Open procedures had more stressful physical postures than laparoscopic procedures. Loupe usage negatively impacted neck postures.

CONCLUSIONS

This study highlights the fact that musculoskeletal disorders are common in surgeons and characterizes surgeons' intraoperative posture as well as surgeon pain and fatigue across specialties. Defining intraoperative ergonomic risk factors is of paramount importance to protect the well-being of the surgical workforce.

Performance Optimization Strategies for Complex Endourologic Procedures

OBJECTIVE

To identify and address factors that may impact a surgeon's performance during endourologic procedures.

METHODS

A literature review was performed for articles focusing on surgical ergonomics, education, sports and performance psychology.

RESULTS

As urologists and trainees have become more comfortable approaching complex pathology endoscopically, there remains an opportunity to refine surgeon-related factors and optimize extrinsic factors to maximize efficiency and provide patients with the highest quality outcomes and safety.

CONCLUSION

Medical centers and training programs should strive to include formal lessons on stress-coping mechanisms, communication, and dedicated ergonomic training, as these all play a role in physician well-being and may lead to improved clinical outcomes.

Workload Differentiates Breast Surgical Procedures: NSM Associated with Higher Workload Demand than SSM

Background

Breast surgery has evolved with more focus on improving cosmetic outcomes, which requires increased operative time and technical complexity. Implications of these technical advances in surgery for the surgeon are unclear, but they may increase intraoperative demands, both mentally and physically. We prospectively evaluated mental and physical demand across breast surgery procedures, and compared surgeon ergonomic risk between nipple-sparing (NSM) and skin-sparing mastectomy (SSM) using subjective and objective measures.

Methods

From May 2017 to July 2017, breast surgeons completed modified NASA-Task Load Index (TLX) workload surveys after cases. From January 2018 to July 2018, surgeons completed workload surveys and wore inertial measurement units to evaluate their postures during NSM and SSM cases. Mean angles of surgical postures, ergonomic risk, survey items, and patient factors were analyzed.

Results

Procedural duration was moderately related to surgeon frustration, mental and physical demand, and fatigue (p < 0.001). NSMs were rated 23% more physically demanding (M = 13.3, SD = 4.3) and demanded 28% more effort (M = 14.4, SD = 4.6) than SSMs (M = 10.8, SD = 4.7; M = 11.8, SD = 5.0). Incision type was a contributing factor in workload and procedural difficulty. Left arm mean angle was significantly greater for NSM (M = 30.1 degrees, SD = 6.6) than SSMs (M = 18.2 degrees, SD = 4.3). A higher musculoskeletal disorder risk score for the trunk was significantly associated with higher surgeon physical workload (p = 0.02).

Conclusion

Nipple-sparing mastectomy required the highest surgeon-reported workload of all breast procedures, including physical demand and effort. Objective measures identified the surgeons’ left upper arm as being at the greatest risk for a work-related musculoskeletal disorder, specifically from performing NSMs.