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Intraoperative musculoskeletal discomfort and risk for surgeons during open and laparoscopic surgery.
Surg Endosc. 2021 11; 35(11):6335-6343.SE

Abstract

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.

Authors+Show Affiliations

Department of Health Sciences Research, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA. Division of Ergonomics, KTH Royal Institute of Technology, Stockholm, Sweden.Department of Health Sciences Research, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.Department of General Surgery, Mayo Clinic, Phoenix, AZ, USA. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Phoenix, AZ, USA.Department of General Surgery, Mayo Clinic, Phoenix, AZ, USA.Department of Health Sciences Research, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.Department of Health Sciences Research, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA. hallbeck.susan@mayo.edu. Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA. hallbeck.susan@mayo.edu. Department of Surgery, Mayo Clinic, Rochester, MN, USA. hallbeck.susan@mayo.edu.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

33083930

Citation

Yang, Liyun, et al. "Intraoperative Musculoskeletal Discomfort and Risk for Surgeons During Open and Laparoscopic Surgery." Surgical Endoscopy, vol. 35, no. 11, 2021, pp. 6335-6343.
Yang L, Wang T, Weidner TK, et al. Intraoperative musculoskeletal discomfort and risk for surgeons during open and laparoscopic surgery. Surg Endosc. 2021;35(11):6335-6343.
Yang, L., Wang, T., Weidner, T. K., Madura, J. A., Morrow, M. M., & Hallbeck, M. S. (2021). Intraoperative musculoskeletal discomfort and risk for surgeons during open and laparoscopic surgery. Surgical Endoscopy, 35(11), 6335-6343. https://doi.org/10.1007/s00464-020-08085-3
Yang L, et al. Intraoperative Musculoskeletal Discomfort and Risk for Surgeons During Open and Laparoscopic Surgery. Surg Endosc. 2021;35(11):6335-6343. PubMed PMID: 33083930.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intraoperative musculoskeletal discomfort and risk for surgeons during open and laparoscopic surgery. AU - Yang,Liyun, AU - Wang,Tianke, AU - Weidner,Tiffany K, AU - Madura,James A,2nd AU - Morrow,Melissa M, AU - Hallbeck,M Susan, Y1 - 2020/10/20/ PY - 2020/05/28/received PY - 2020/10/03/accepted PY - 2020/10/22/pubmed PY - 2021/10/26/medline PY - 2020/10/21/entrez KW - Laparoscopic surgery KW - Musculoskeletal disorders (MSDs) KW - Open surgery KW - Surgical ergonomics KW - Wearable sensor KW - Work posture SP - 6335 EP - 6343 JF - Surgical endoscopy JO - Surg Endosc VL - 35 IS - 11 N2 - 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. SN - 1432-2218 UR - https://www.unboundmedicine.com/medline/citation/33083930/Intraoperative_musculoskeletal_discomfort_and_risk_for_surgeons_during_open_and_laparoscopic_surgery_ DB - PRIME DP - Unbound Medicine ER -