Do Micropauses Prevent Surgeon's Fatigue and Loss of Accuracy Associated with Prolonged Surgery? An Experimental Prospective Study

Abstract

from 9.8% to 5.5% (P ¼ .004), and 1-year major amputation decreased from 25.4% to 18.2% (P < .001), with a corresponding odds ratio of 0.65 (95% CI, 0.517-0.838; P < .0001) as the volume increased. An increase in the chance of a revision surgery (10.6% vs 8.2%, P < .001) was seen with higher volume, with an increased odds ratio of 1.031 (95% CI, 1.005-1.057; P ¼ .018). Comment: Although the 30-day mortality for leg bypass is quite high in this series, this is another bit of evidence that outcomes for open vascular surgical procedures are better in hospitals with higher volumes of such procedures. The data have some limitations because it is unclear whether every procedure analyzed was an additional bypass, followed a failed endovascular procedure, or was a vein or prosthetic bypass. There are some additional oddities in the data, in that 54% of the patients treated with femoral distal bypass were supposedly treated for claudication. Nevertheless, the relationship between increasing volume and favorable outcomes for LEAB seems statistically solid. The data also suggest that benefits for limb salvage may be partly due to increased reintervention rates in higher-volume hospitals with perhaps better resources and willingness to attempt revisions rather than move to amputation.

The Influence of Micropauses on Surgeons’ Precision After Short Laparoscopy Procedures

“…Another important weakness of our study is a relatively simple validation of our smartphone-based test. On the other hand the rules of using the application and its results are quite similar to other, clinically validated tests for surgical precision (2).…”

“…The link between long surgical procedures and a surgeon's fatigue, decreased strength, and decreased technical accuracy has been identified before (2). Longer surgical procedures result in significant muscle fatigue and impairs surgical precision (3).…”

“…Back pain, neck pain and muscle fatigue are important source of distress for surgeons and can influence their performance and precision of movements (1). Recently it has been shown that performing short breaks (micropauses) every 30 minutes during long surgical procedures can result in better precision, less fatigue and better maintenance of hand force (2).…”

Workload Differentiates Breast Surgical Procedures: NSM Associated with Higher Workload Demand than SSM

“…Use of microbreaks 28,29 may be beneficial, as may a change in technical approach. 31,32 Microbreaks encourage the surgeon and the surgical team to change position and stretch at designated periods throughout a procedure and they have been shown to increase physical function and mental focus. 33 Our data indicate that these interventions may not be necessary during lumpectomy or excisional biopsy procedures, but more appropriate for skin-sparing and nipple-sparing mastectomies-the longer and more fatiguing procedures.…”

The Association of Shelter Veterinarians’ 2016 Veterinary Medical Care Guidelines for Spay-Neuter Programs

“…302 Micropauses of 15 to 30 seconds taken multiple times per hour reduce discomfort and fatigue and increase accuracy, especially if combined with active stretching or exercises that release the neck and shoulder tension inherent in surgical posture. 306,307 Surgical tasks in HQHVSN programs require a combination of repetitive movements that can at times require force or may be performed with awkward positioning of the hands and wrists. Alone, each of these factors (repetition, force, and posture) is only moderately associated with musculoskeletal discomfort of the hand and wrist; however, when combined, their association with musculoskeletal discomfort is strong.…”