EXECUTIVE SUMMARY

Healthcare systems engineering professionals are designing ways to help surgeons reduce their neck, shoulder, and back pain.

  • One method is for surgeons to take short breaks for every 45 minutes to one hour of surgery.
  • Another technique, under development now, is for surgeons to wear an exoskeleton, which would support their torso and arm during surgical procedures.
  • A third potential option would be a shirt that places sensors on the surgeon and creates a personal report about his or her posture. The system includes a device that fits into the pocket of a compression shirt that is worn underneath scrubs.

Surgeons frequently report neck, shoulder, and back pain, but will work through it, even if chronic pain could force them into early retirement.

“Surgeons typically believe it is part of their culture to be in pain,” says Susan Hallbeck, PhD, PE, CPE, scientific director for health care systems engineering at the Mayo Clinic in Rochester, MN. “They just work hard and go into the operating room (OR), not leaving until the patient is off the table. And they don’t take breaks. It’s the culture.”

Research shows surgeons give their highest pain rating to neck pain, which could be a symptom of poor posture and neck flexion issues. “I can say that surgery is a pain in the neck,” Hallbeck says. “Surgeons fear that the pain they have from OR will reduce their ability to perform future surgeries.”

Hallbeck and colleagues tested 53 surgeons who performed 116 procedures at the Mayo Clinic’s Arizona location.1 They followed surgeons from the incision time to close time, observing their posture and ergonomics during surgery. The authors noticed surgeons did not leave the OR during procedures. While performing operations, these surgeons leaned forward more, with overall poor posture.

Investigators compared open surgeries for those with and without loops-magnifying glasses. They observed using the loops-magnifying glasses increased neck flexion by 10 degrees, on average, she says.

“When we took data about their pain scores in their neck and upper back and lower back and arms, prior to surgery and after surgery, we found that the most common place for increasing pain was in their neck,” Hallbeck reports. “Fifty-two percent of surgeons in our study had increased pain after surgery in their neck; 45% had it in the lower back, and 43% had pain in the upper back.”

Ergonomic solutions in the OR are different from solutions in other industries because there is less flexibility in adjusting the work environment. “In a car repair shop, you can position the car to allow easier access by the person working on the car,” Hallbeck explains. “With patients, we can’t position the patient differently because of all the issues of having a human being on a table and having to keep their heads from being too low.”

Solutions can focus on the surgeons’ actions. For example, surgeons who take microbreaks to stretch every 45 minutes to an hour can help prevent neck pain, Hallbeck says. An alarm can remind surgeons to take these breaks. Researchers found almost everyone who tried this approach liked it, and taking the microbreaks did not affect overall surgery time.

“One big pushback was the idea it would extend surgery duration, and we found it did not,” Hallbeck says. “It increased people’s physical performance and mental focus, and it decreased mental fatigue.”

After trying the microbreak exercise intervention, some surgeons gave positive feedback: “I got a fist bump from one surgeon who had been in the military,” Hallbeck says. “He said he wasn’t crawling out of the OR in pain at the end of the day.”

Technological advancements also could provide solutions to surgeons’ neck and back pain. For example, they could wear an exoskeleton during surgery. This would support their torso, and would be especially useful in supporting a surgeon’s arm, Hallbeck says.

“Some surgeons keep a posture for a long period of time, with their arm outstretched and away from their body,” she adds. “We’re working with companies to bring the exoskeleton into the operating room to test it out.” The prototypes can fit outside the scrub, but under the gown and pass infection control standards. One version supports front and back weight by pushing on the front of the thigh, and another supports the arm as it is raised parallel to the floor, Hallbeck explains. “There is a spring system that allows you to rest your arm, like resting on a table, and it reduces the weight of your arm as its held up away from your body,” she says.

Some versions of exoskeletons are commercially available, and investigators will study them to see which works best. Another potential is a combination shirt and sensors. While wearing this special shirt and sensors, the solution monitors movement and generates a personal report about posture, neck flexion, and torso and arm angles. “We’re working with a company to make sensors that go into the pocket of a compression shirt that is worn underneath scrubs,” Hallbeck says.

Surgeons can use these daily reports to train themselves to maintain a better posture. The sensors also can vibrate to alert surgeons to problems that could lead to pain. This type of technology could be used during resident training, helping young surgeons develop productive habits, Hallbeck offers.

Technological improvements make it possible to provide effective body movement instruction and correction without the inconvenience of previous methods. “There have been studies that looked at the postures of surgeons. [Researchers] put tape on the gown and watched [surgeons]. That’s very difficult because the gowns don’t move with the person as well as the sensors that are attached to surgeons’ bodies,” Hallbeck observes.

Also, modern surgeries and procedures exact a greater toll on surgeons’ bodies. “What surgeons are doing now is cutting-edge, and each year that edge gets further involved,” Hallbeck says. “Think about elite athletes, which is what OR doctors are, and most athletes do not have a career after age 40. We’re asking surgeons, who don’t get to be an attending until [age] 35, to start a career then ... there is some evidence that their longevity is not as long as it used to be.”

Technology and other methods to reduce surgeons’ pain in the OR could help preserve surgeons and prevent shortages.

“We need more surgeons than we have. When people retire early from doing surgery, it changes their own quality of life and also is bad for surgical access for patients,” Hallbeck says. “If someone wants to retire at [age] 50 because they’re done, that’s different from having to leave the OR ... before they’re ready.”

REFERENCE

  1. Yang L, Money SR, Morrow MM, et al. Impact of procedure type, case duration and adjunctive equipment on surgeon intraoperative musculoskeletal discomfort. J Am Coll Surg 2020;230:554-560.