Surgeons Suffer from Highest Rate of Work-Related Musculoskeletal Disorders, Pain

Surgeons work long hours, often finding themselves in cramped, awkward positions as they hold human life in their hands. That stress adds up, new data suggests, and can frequently manifest in insidious pain that results in temporary, and in some cases permanent, work disability.

The prevalence of work-related musculoskeletal disorders (MSD) is much higher in surgeons and interventionalists than other physicians, according to the new study, published December 27 in JAMA Surgery. The difference is substantial — a surgeon’s work environment and risk for work-related MSDs can be more accurately compared to those of coal miners, manufacturing laborers, and physical therapists, according to ergonomists referenced in the study.

Bernard Lee MD

Bernard Lee, MD, MPH, MBA

Lead author Bernie Lee, MD, MBA, and colleagues of the Department of Surgery at Beth Israel Deaconess Medical Center, pulled together 21 articles for a systematic review that included 5828 physicians (mean age 46 years, 78.5% male, 12.8 years in practice, 14.4 hours performing procedures per week).

“I’m a plastic surgeon by training and I do a lot of microsurgery. I wear loops, I wear head lights, and I’m plagued by constant neck pain and back pain,” Lee said in a podcast interview with the JAMA Network. “As we pulled all the papers and data, it started to make sense to me that we should put together a systematic review looking at [workplace ergonomics and MSDs], because these are common symptoms and disorders that we discuss with our colleagues all the time.”

The review found that there are high prevalence estimates of work-related MSDs, a range of disability burden that includes early retirement, and a high demand, but poor supply of interventions. Pooled crude prevalence estimates of the most common work-related MSDs were as follows:

• Degenerative cervical spine disease in 17% (457 of 2406 physicians, 95% CI)
• Rotator cuff pathology in 18% (300 of 1513 physicians, 95% CI)
• Degenerative lumbar spine disease in 19% (544 of 2449 physicians, 95% CI)
• Carpal tunnel syndrome in 9% (256 of 2449 physicians, 95% CI)

From 1997 to 2015, prevalence of degenerative cervical spine disease and degenerative lumbar spine disease increased by 18.3% and 27%, respectively. Of those with a work-related MSD, 12% (277 of 2319 physicians, 95% CI) required a leave of absence, practice restriction or modification, or early retirement. Moreover, 12 at-risk specialties described a gross lack of awareness and an unmet need for ergonomics education.

“The number 1 thing we need to do is improve awareness,” Lee said. “We need to know that this is a problem. We need to improve awareness from the earliest levels, whether it’s in residency or even as a medical student. Ergonomics is an important thing in the operating room, and it’s important for a long career.”

In addition to work-related MSDs, researchers found a high incidence of work-related musculoskeletal pain in 18 cross-sectional studies. Twelve of 18 studies were eligible for the quantitative synthesis, and included a pooled sample of 2815 physicians. Most were orthopedic surgeons (n=1264), gynecologists (n=495), and dermatologists (n=371) located in North America (n=1989).

The overall 12-month prevalence of estimates of specific pain types were as follows:

• Neck pain: 60% (1131 of 1921 physicians, 95% CI)
• Shoulder pain: 52% (802 of 1360 physicians, 95% CI)
• Back pain: 49% (123 of 2254 physicians, 95% CI)
• Upper extremity pain: 35% (588 of 1343 physicians, 95% CI)

“A lot of these work-related MSDs depend on positioning, and on standing in awkward positions for long periods of time, often with heavy equipment, weights on your head, and heavy gowns,” Lee said. “The question is whether or not we can identify potential areas where we can improve ergonomics in the operating room and be more aware of our body positioning, and things we can do to change our physical environment in the operating room.”

The review identified several assessments of ergonomics stating that interventionalists lack awareness of applied ergonomics recommendations. Moreover, 12 at-risk specialties from 8 countries published at least 1 article describing a need for ergonomics education during medical training. On the other hand, a few studies found that ergonomics education during medical training appeared feasible and effective at changing behaviors and reducing symptoms.

For Lee, improving education and interventions is the key.

“We don’t have to live in isolation and think about how we have back pain and neck pain all the time. That could contribute to things like burnout. [Education and interventions] could be a big element towards improving physician health, especially in the surgical and interventional specialties,” he said.

The meta-analysis, Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists, was published December 27 in JAMA Surgery.