Surgeons who take 90-second breaks to perform a variety of stretching exercises during procedures may be doing themselves—and their careers and patients—a big favor. That’s the conclusion of a study conducted by Adrian E. Park, MD, FACS, FRCS, chair of surgery at Anne Arundel Medical Center (AAMC), Annapolis, MD, and professor of surgery, Johns Hopkins University School of Medicine, Baltimore, MD.*
In the study, published online ahead of print in the Annals of Surgery, Dr. Park and his colleagues reviewed the pain, fatigue, and the physical and mental performance of 66 surgeons and operating room (OR) staff during their performance of nearly 400 operations at four medical centers—AAMC; Mayo Clinic, Rochester, MN; Carolinas Medical Center, Charlotte, NC; and the University of Louisville Medical Center, KY. The researchers recorded the surgical procedure and its duration, along with the level of surgeon pain before and after each procedure. They also measured the level of pain at the end of the operating day. Surgeons who took 90-second pauses reported improvements in their physical and mental well-being.
TSMBs improve surgeon and patient safety
The researchers asked participants to perform a series of “targeted stretching micro breaks” (TSMBs) every 20 to 40 minutes while maintaining sterile technique. The TSMBs involved five structured exercises, including neck flexion, extension, and lateral rotation; backward shoulder rolls with chest stretch; upper back and hand stretch; low back flexion and extension with gluteus maximus squeezes; and forefoot and heel lifts for lower extremity and ankle stretches.
“While the impact of TSMBs on patient safety remains to be defined,” Dr. Park said, “we know that addressing ergonomic risk will enhance surgeons’ productivity, well-being, and endurance, which are all factors that help maximize patient safety in the operating room.”†
Most study participants (57 percent) reported that TSMBs resulted in improvements in their physical performance, and 38 percent reported improved mental focus. Surgeons also reported significantly reduced pain scores when they used TSMBs intraoperatively. Importantly, 87 percent of the participants said they want to incorporate TSMBs into their ORs.
Longstanding interest in ergonomics
Dr. Park is not a newcomer to ergonomic issues. He has experienced his profession’s occupational hazards—and knows firsthand about the neck, back, and head pain that often follow hours in the OR, particularly as surgeons perform increasingly complex surgical procedures.
“I have been aware for a long time that in providing the best outcomes for our patients, surgeons often compromise our own health and well-being. I’ve gone around the country talking to other surgeons about ergonomics for many years now,” Dr. Park said. He recalls his own surprise when he first began to experience physical pain after leaving the OR. “I was a young, sports-oriented guy who was enthusiastic about laparoscopic procedures. My patients clearly benefited from the procedures, but surgeons need to start looking out for their own well-being as well.”
Indeed, the procedures that benefited his patients left him with pain and numbness. “Both of my wrists have been operated on,” he said. “Surgeons have no problem complaining about all kinds of things related to their work, but the one thing they don’t complain about is their own physical well-being,” Dr. Park said. “I’m not sure why that is. There may be a certain altruism underlying it, or they may be concerned about the effects their complaints might have on their referral base.”
That attitude may be changing. According to Dr. Park, more surgeons have begun to take the first step to address the problem—admitting that one exists. “We’re starting to make it all right to talk about this,” he said. “Whenever I speak before groups about this, I hear so many testimonials. People tell me they’re glad I brought this up because pain has incapacitated them and limited their surgical practice.
“We’re looking at a pandemic of surgical injury,” Dr. Park added. The solution most likely lies in a multi-pronged effort. “We’re trying to communicate that this is not just a surgeon’s issue.” He pointed out that the issues have ripple effects on health policy planners, hospital administrators, insurance companies, and patients. “We are facing a growing delta between anticipated workload for surgeons and static or declining surgical workforce over the next decade,” Dr. Park said. Shortened careers as a result of physical pain and injuries clearly exacerbate the problem.
“We need more research and funding in this area, and we need new technological advances informed by the research,” he said. “The amount of understanding of our workspace is still so minimal.”
How do surgeons cope with the physical pain of practicing? “They often take steps to change positions during procedures, adjust the surgical field, or take short breaks. There have been cases of surgeons taking extended breaks from their jobs,” Dr. Park said. Sometimes the pain leads to overmedicating and substance abuse. A study published in the May 2013 Journal of Addiction Medicine indicated that of health care professionals, surgeons have among the highest risk for substance abuse.‡ Most commonly, however, surgeons simply try to ignore the pain, he said.
They may not be able to continue ignoring it. Many surgeons are discussing the physical toll they experience as a result of their jobs. Carol Scott-Conner, MD, PhD, FACS, professor emeritus of surgery at the University of Iowa Carver College of Medicine, Iowa City, opened a discussion earlier this year in the online ACS Communities regarding ergonomics. “I am interested in learning whether ergonomic issues are prevalent among general surgeons,” she wrote. “I originally postulated that women might be more vulnerable: smaller hands in general, differently sized bodies, different ‘carrying angle,’ for example. Acknowledging that this is not a women’s problem, per se, but can affect anyone whose body does not fit the standard mold, I thought I would start here.” She posted this inquiry first to the Women Surgeons Community and then to the General Surgery Community.
Dr. Scott-Conner’s comment generated a barrage of responses, as surgeons shared their common experiences with the pain and discomfort that often accompany their time in the OR.
“There was a flurry of interest in this topic when laparoscopic surgery first came out, and there was some redesign of handsets, but interest seems to have waned,” Dr. Scott-Conner said. “I have had ergonomic problems over the years, and I’m wondering if this topic is due for some additional study.”
Results from several recent surveys point to the same general conclusion; surgeons face occupational hazards in the OR. The University of Texas MD Anderson Cancer Center, Houston, for example, recently conducted a survey of the workplace injuries suffered by oncologic surgeons. The researchers concluded that ergonomic issues in the OR are serious and that surgeons may need the assistance of ergonomic experts to improve their posture to avoid lower back injuries. These results are in line with Dr. Park’s concerns about ergonomic stress in the OR, but he urges his colleagues to continue studying the issues—and to continue the discussion.
*Park AE, Zahiri HR, Hallbeck MS, et al. Intraoperative “micro breaks” with targeted stretching enhance surgeon physical function and mental focus: A multicenter cohort study. Annals of Surgery. Available at: www.researchgate.net/profile/Adrian_Park/publications. Accessed April 26, 2016.
†Anne Arundel Medical Center. Study shows brief stretching during surgery improves surgeon performance, pain [press release]. Available at: www.aahs.org/news/?p=10791. Accessed May 13, 2016.
‡Merlo LJ, Singhakant S, Cummings SM, Cottler LB. Reasons for misuse of prescription medication among physicians undergoing monitoring by a physician health program. J Addict Med. 2013;7(5):349-353.