Enhancing surgical ergonomics for surgeon well-being and patient care

Optimizing the environment can measurably reduce physical strain

The demands of surgery exert a considerable mental and physical toll, necessitating an optimized surgical environment for safety, efficiency, and quality of life. Increasing awareness has sparked interest in improving surgical ergonomics to address these challenges.

Ergonomics focuses on tailoring the environment to accommodate the worker, rather than the other way around. This approach can be applied to the surgical setting in various ways, encompassing the layout of the operating room, equipment design, and the surgeon’s posture and techniques.

Dr. Amy Park, Section Head of Female Pelvic Medicine & Reconstructive Surgery at Cleveland Clinic’s Ob/GYN & Women’s Health Institute, emphasizes the need for surgeons to maintain mental sharpness, physical dexterity, and situational awareness, similar to high-performance athletes. Simultaneously, they face physically demanding work, prolonged ergonomic strain, and harsh working conditions, often neglecting their own well-being.

Dr. Park, a founding member of the Society for Surgical Ergonomics, highlights the significance of these persistent stressors for both surgeons and their patients, as well as the healthcare community as a whole.

Understanding the Issue

Poor ergonomics in the surgical field can lead to several work-related musculoskeletal disorders with substantial, long-term consequences, such as carpal tunnel syndrome, epicondylitis, neck tension syndrome, shoulder tendonitis, and rotator cuff injuries.

Overexertion and repetitive-use injuries can result in reduced productivity, absenteeism, and related costs. Dr. Park notes that in a survey, 40% of surgeons reported at least one work-related injury, with 50% of them seeking medical treatment, and only 19% informing their institutions.

Dr. Park identifies three stages of work-related musculoskeletal disorders:

• Stage 1: Symptoms occurring during work hours that resolve.
• Stage 2: Symptoms persisting overnight after work.
• Stage 3: Symptoms persisting at rest, affecting sleep, and lasting for months to years.

Such injuries can significantly impact a surgeon’s career, potentially leading to missed work, reduced caseload, or other changes in their practice, and in some cases, forced retirement. Dr. Park points out that at-risk physicians make up about 20% of the active workforce, contributing to an expected shortage by 2025, with disability being a contributing factor. A culture of silent suffering exacerbates poor ergonomics and pain among surgeons and perpetuates a lack of awareness regarding the issue. While there’s growing recognition and momentum in the field, further education and awareness are essential.

Education and Support

Ergonomic training has proven effective. In one study, 88% of surgeons altered their practices after in-person training, with 74% reporting reduced strain.

Ergonomic adjustments include optimizing chair positions, ensuring 90-degree knee flexion, maintaining forearms parallel to the ground with elbows tucked at the sides, limiting head flexion to less than 20 degrees, and minimizing forehead pressure on headrests. Surgeons should focus on maintaining a neutral position and relaxing their hands, rather than constant clenching.

Such interventions have shown positive results, reducing lost workdays, enhancing efficiency, cutting costs, reducing material and equipment waste, bolstering corporate image, and increasing employee satisfaction.

Best practices involve keeping extremities close to the body, using compliant mats to reduce spinal disc strain from prolonged standing, and alternating between sitting and standing. The monitor and table height also play a critical role.

Dr. Park recommends taking microbreaks during procedures, stretching for 1.5 minutes every 20 to 40 minutes, which has been associated with improved mental focus and physical performance without extending the operating room time.

Surgeons can use the Microbreak Stretch app, which demonstrates appropriate stretches. Dr. Park emphasizes the importance of neck, hamstring, and back stretches immediately after leaving the operating room. Integrating stretching and flexibility exercises into personal fitness routines and regular massage therapy can also be valuable.

Institutions have a vital role to play by fostering a culture that acknowledges injuries and emphasizes protective measures. They should engage with surgeons at all levels of training and correlate pain or discomfort symptoms with ergonomic assessments and tissue damage. Institutions must strive to shield surgeons from preventable, potentially career-altering, or career-ending injuries.

Source: consultqd.clevelandclinic.org