Surgical Trainees Have Similar Ergonomic Risk In The Operating Room As Experienced Surgeons
*Dimitrios I. Athanasiadis1, *Sara Monfared1, *Hamed Asadi2, *Denny Yu2, Dimitrios Stefanidis1
1Indiana University School of Medicine, Indianapolis, IN;2Purdue University, West Lafayette, IN
OBJECTIVE(S): Work-related musculoskeletal injuries have been increasingly recognized to affect surgeons. Whether such injuries also affect surgical trainees is less clear. Identifying surgeons at risk for developing musculoskeletal injuries may enable preventative interventions. The purpose of this study was to assess the ergonomic risk of surgical trainees and compare it to that of experienced surgeons.
METHODS: Using an IRB-approved prospective protocol, ergonomic data were recorded from 6 experienced surgeons and 10 residents/fellows. Biomechanical loads during surgery were assessed using wearable, wireless, and unobtrusive motion tracking sensors and surface electromyography (EMG) sensors. Demanding and static positions of the trunk, neck, right/left shoulder, as well as activity from the deltoid and trapezius muscles bilaterally, were recorded. In addition, participants were asked to report their perceived body discomfort and workload on validated questionnaires. Body position, muscle activity, and perceived discomfort were compared between the subjects using t-test. A multivariate analysis was performed to control for gender, age, and years of experience.
RESULTS: A total of 101 observations were completed including 87 laparoscopic and 14 robotic procedures consisting of bariatric and general surgery operations (sixty observations of the attendings, and 41 of the trainees). Demanding and static positions of the trunk, neck, right and left shoulder, as well as perceived body discomfort and workload, did not differ significantly between attendings and trainees. Both groups experience a high percentage of time in static position (above 60%) and demanding position (above 10%). While experienced surgeons had higher mean EMG activity of the right trapezius, left deltoid and left trapezius on our bivariate analysis, the multivariate analysis showed only right trapezius activity remaining statistically significant (p<0.01).
CONCLUSIONS: Besides having lower muscle activity particularly in the right trapezius, surgical trainees spend a high percentage of time in static and demanding postures (known risk factors for musculoskeletal injuries) and report discomfort similar to attendings. Our findings suggest that trainees are exposed to similar ergonomic risk as experienced surgeons, and given that the effect of musculoskeletal injuries is cumulative over time, they may be the ideal target for interventions aiming to reduce ergonomic risk and injuries in the operating room.
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