Work-Related Musculoskeletal Injury Common in Surgeons, Interventionalists

Veronica Hackethal, MD

December 28, 2017

Surgeons and medical interventionalists are at high risk for work-related musculoskeletal disorders, with rates comparable to construction workers, according to a systematic review and meta-analysis published online December 27 in JAMA Surgery.

The study is the first synthesis of the topic to date, and throws light on a problem many physicians face during their careers.

"These are common symptoms and common disorders that we discuss with our colleagues all the time. When we pulled all the data together, it was alarming and surprising to us that this was pervasive," lead author Bernard Lee, MD, MPH, MBA, a plastic surgeon at Harvard Medical School in Boston, Massachusetts, said in a JAMA Surgery podcast.

Many work-related musculoskeletal disorders depend on positioning, he explained, and result from standing in awkward, static positions for long periods of time, often with heavy equipment worn on the head, or heavy gowns worn on the body.

Long hours spent performing repetitive movements and less-than-ideal instrument design can also add to the wear and tear on surgeons' bodies. Such problems can cause some surgeons to cut back on procedures, take time off from work for rehabilitation or surgery, and even shorten careers.

The problem is so significant that some experts have referred to it as "an impending epidemic," and fear that it may contribute to the projected shortage of surgeons in coming years. Some studies suggest a higher prevalence of work-related musculoskeletal disorders among surgeons and interventionalists than among coal miners, manufacturing laborers, and physical therapists. Others have reported that up to 80% of at-risk physicians may experience significant work-related pain.

However, most of the data are limited or anecdotal. To provide more evidence, Dr Lee and colleagues searched four databases and two clinical trial registries for studies on work-related musculoskeletal disorders in surgeons and medical interventionalists. The analysis included 21 articles published in English or Spanish in 23 different countries between 1974 and 2016 and encompassed data from 5828 physicians. Participants were 78.5% male (mean age, 46.0 years), had been in practice for roughly 12.8 years, and spent about 14.4 hours per week performing procedures.

Pooled crude prevalence estimates showed that the most common work-related musculoskeletal disorder was degenerative lumbar spine disease, with an overall career prevalence (OCP) of 19% (95% confidence interval [CI], 13% - 27%).

Other common disorders included degenerative cervical spine disease (OCP, 17%: 95% CI, 12% - 25%), rotator cuff injury (OCP, 18%; 95% CI, 13% - 25%), and carpal tunnel syndrome (OCP, 9%; 95% CI, 5%-16%).

Results also showed that the overall prevalence of neck, shoulder, back, or upper extremity pain in the last 12 months ranged from 21% to 60%, although results varied depending on how studies assessed pain.

Among physicians who experienced work-related musculoskeletal disorders, 12% (95% CI, 7% - 18%) needed to take a leave of absence, had to modify or restrict their practice, or entered early retirement.

Twelve specialties in eight countries reported the need for ergonomics education.

The results point to the need for evidence-based ergonomics programs for surgeons and interventionalists, according to the authors. Such programs should be integrated with other types of wellness programs designed to prevent physician burnout, attrition, and suicide. First and foremost, however, is the need for awareness and frank discussion about the problem.

"The number one thing we need to do is improve awareness. We need to know that this is a problem. We need to improve awareness from the earliest levels, whether in residency or even in medical school," Dr Lee said in the podcast, "[Ergonomics] could be as simple as standing up straight, or making sure that your neck is in the right position, or making sure that you're not bending halfway over the table to do something."

The authors mentioned study several limitations, including the possibility of bias arising from methodological issues in the included studies.

The study was partially funded by a grant from the National Institutes of Health. The authors have disclosed no relevant financial relationships.

JAMA Surg. Published online December 27, 2017. Full text

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