Ergonomics Among Craniofacial Surgeons: A Survey of Work-Related Musculoskeletal Discomfort and Injury

Abstract

Introduction: Surgical procedures with loupe magnification, headlights, and microscopes expose craniofacial surgeons to mechanical stress that can increase risk of long-term musculoskeletal pain and injury. Identifying the prevalence and cause of work-related musculoskeletal discomfort may guide preventative strategies to prolong well-being, job satisfaction, and greater duration of surgical careers. Methods: A 29-question online survey was distributed to the surgeon members of the American Cleft Palate-Craniofacial Association. Eight hundred seventy-three surveys were distributed, and the anonymous responses were recorded using Google forms. Results: One hundred ninety-six unique responses were recorded (22.5% response rate). A total of 64.2% reported experiencing musculoskeletal symptoms during their career, with neck, lower back, and shoulders being the most common problem areas. Multivariate analysis demonstrated surgical loupes (odds ratio 2.36, P ¼ 0.03) and length of surgical practice >15 years (odds ratio 1.95, P ¼ 0.04) were independently associated with greater odds of developing symptoms. Headlights (median pain ¼ 3, P < 0.001), loupes (median pain ¼ 3.5, P < 0.001), and operative microscope use (median pain ¼ 2, P ¼ 0.02) were all associated with higher pain while operating. A total of 52.5% respondents sought medical treatments, 50.5% were concerned musculoskeletal discomfort would affect their careers, 56.6% reported a colleague that required an operation, and 30.2% reported a colleague on temporary or permanent disability. Conclusions: Craniofacial surgery often involves long procedures, use of surgical adjuncts, and ergonomically straining postures, which can lead to musculoskeletal discomfort and injury. This under-reported and important phenomenon merits candid conversation and active preventative strategies to prolong surgical careers, improve professional satisfaction, and maximize patient safety.

Utility of a Neuromuscular Activation Exercise Protocol on Surgeon Posture

“…1,2 Surgical specialties, such as plastic surgery that involve long procedure length, surgical loupes, headlamps, and microscopes, put surgeons at a higher risk. [3][4][5] Additionally, static positioning, repetitive surgical motions, and hyperflexion of the cervical spine contribute to poor surgical ergonomics. 6 Literature shows that over 80% of surgeons suffer from pain when performing procedures, however, no standardized intervention or prevention program exists.…”

“…6 Literature shows that over 80% of surgeons suffer from pain when performing procedures, however, no standardized intervention or prevention program exists. 1,5,7 Previous research has established a need for better education and interventions directed at surgical ergonomics. 1,4,6,[8][9][10] These studies have largely focused on surveying surgical attending physicians and residents, but there is a paucity of data directly and prospectively examining or treating poor ergonomics intraoperatively.…”

“…The most common pathologies include degenerative and overuse injuries of the cervical and lumbar spine, rotator cuff, and carpal tunnel 1,2 . Surgical specialties, such as plastic surgery that involve long procedure length, surgical loupes, headlamps, and microscopes, put surgeons at a higher risk 3–5 . Additionally, static positioning, repetitive surgical motions, and hyperflexion of the cervical spine contribute to poor surgical ergonomics 6 .…”

“…Additionally, static positioning, repetitive surgical motions, and hyperflexion of the cervical spine contribute to poor surgical ergonomics 6 . Literature shows that over 80% of surgeons suffer from pain when performing procedures, however, no standardized intervention or prevention program exists 1,5,7 …”