Musculoskeletal Pain and Ergonomics Among Plastic Surgery Residents: Results of a National Survey and Analysis of Contributing Factors
George Kokosis1, Lee A. Dellon, MD1, Scott T. Hollenbeck, MD2, Bernard T. Lee, MD, MBA, MPH, FACS3, Devin Coon, MD. MSE1.
1Johns Hopkins University, Baltimore, MD, USA, 2Duke University, Durham, NC, USA, 3Harvard University, Boston, MA, USA.
Musculoskeletal injuries among surgeons are under-estimated, but are increasingly recognized to constitute a major problem with reported prevalence of symptoms and of true injuries approaching 80% and 27% respectively. This is thought to be the result of of damage to the body throughout cumulative years of practice. However, it has not been established when symptoms start and what factors contribute to the development and progression of symptoms. METHODS: A 19-question survey approved by our institution`s IRB and ACAPS was sent to all plastic surgery residents. Predictors of these symptoms were evaluated. Respondents were asked how often they have pain after operating and categorized into frequent/symptomatic (“every case”/“often”) versus asymptomatic (“not often”/“never”). Assessment of dichotomous variable predictors was performed using logistic regression with ordered logistic regression for multilevel ordered variables (e.g., Post Graduate Year level).
RESULTS: We received 104 total responses. 94% of residents had experienced musculoskeletal pain in the operating room. The neck was the most commonly affected area (54%) followed by the back (32%) and extremities (12%). Interestingly, 52% of responders developed these symptoms during the first two years of their residency. Furthermore, increasing PGY level (p = 0.3) and independent versus integrated status (p = 0.6) had no correlation with pain, suggesting that symptoms began early in training.Pain symptoms were frequent for 47%, while 5% reported experiencing symptoms during every case. The use of a headlight correlated with frequent pain (OR=2.5, p=0.027). The use of microscope and loupes did not correlate with frequent pain. Eighty-nine percent of responders were aware of having bad surgical posture, but only 22% had received some form of ergonomics training at their institution. 64% of responders believe that the operating room culture does not allow them to report the onset of symptoms and ask for adjustments. This was more common among residents reporting frequent pain (OR 3.12, p=0.009).
Plastic surgeons are at high risk for occupational symptoms and injuries. Surprisingly, symptoms start early during residency and are not simply related to complex cases such as microsurgery. Eighty-nine percent of residents believe they have poor surgical posture and almost half report frequent pain after operating, yet the majority do not receive formal ergonomics training. As residents are aware of the problem and looking for solutions, this suggests an opportunity for educational intervention to improve the health and career longevity of the next generation of surgeons.
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