The Problematic Ergonomics of Surgery

The concept of ergonomics is typically applied to office settings in which chair, desk, keyboard, and monitor placement are key factors to avoiding workstation discomfort. Many may not realize, however, that other workplaces – such as operating rooms – are also rife with ergonomic stressors.

Operating rooms are designed to facilitate the comfort and safety of patients. Meanwhile surgeons and care staff may endure less-than-ideal, prolonged postures while providing critical care.

In a recent study, “The risk of ergonomic injury across surgical specialties,” published by PLOS One, the authors write, “The operative tasks, which surgeons undertake every day, require not only mental sharpness, concentration, hand-eye coordination and precise execution of movement, but also minutes to hours of sustained posture with prolonged static exertion.”

More complex surgeries can take 8-plus hours – as in this case of removing a medulloblastoma, which took 10 hours to complete.

The study surveyed 167 surgeons from specialties including neurosurgery, plastic, general, vascular, otolaryngology, ophthalmology, cardiology, obstetrics and gynecology, as well as interventional radiologists to better understand surgeons’ work-related musculoskeletal pain, operating room challenges and level of ergonomic training.

Extent and Location of Pain

The PLOS One study uncovered the following key data on how and where surgeons experience work-related musculoskeletal pain:

• • 69.4% of respondents reported pain while operating with the most common location of pain reported in the lumbar and cervical regions
  • 53.9% of surgeons responded that standing was the most common position that led to pain
  • 51.7% reported having pain at least once a week
  • 59.5% of participants reported that pain impacted their life outside of work
  • 47.6% stated that pain affected their work

During a long surgery, it is common for surgeons to stand with their head and shoulders leaning forward and their back hunched, which can lead to musculoskeletal pain. However, the authors of “Physician safety is patient safety: Good surgical ergonomics to optimize patient care,” a recent article in the American Academy of Otolaryngology – Head and Neck Surgery magazine bulletin, suggest that a better posture would be to maintain the natural curvature of the spine, with an inward curve of the lower back and neck and an outward curve in the thoracic spine.

The Operating Room Environment

For the most part, operating rooms are configured with the best interests of the patient in mind, and not necessarily the surgeons themselves. It is not surprising, therefore, that the PLOS One study found that 71.8% of surgeons surveyed stated that they had no access to ergonomic chairs and stools in the operating room at all.

Adjusting the table height in the operating room so that the patient is waist level to the surgeon can help improve surgeons’ posture, according to the bulletin article. Additionally, surgeons should be given the option to sit or stand on a stool or platform to help them achieve the correct positioning needed.

Yet operating tables are rarely adjusted to the appropriate height for the attending surgeon, according to the bulletin article. In fact, many surgeons stated that they were unaware of the full range of adjustable features available to them in the operating room.

Lack of Training on Ergonomics of Surgery 

The surveyed surgeons in the PLOS One study revealed some surprisingly low numbers in regards to ergonomic training. Among the key findings:

• • 76% of participants reported that they had had no prior ergonomics training
  • Only 5.2% reported that they had received ergonomics training during medical school
  • 8.4% received the training in residency
  • Only 1.9% received training from an expert consultation

Although Duke University includes a mandatory program on surgical ergonomics for its junior residents, such curriculum is rarely formalized. In 2019, a survey study, “The Current State of Surgical Ergonomics Education in U.S. Surgical Training,” published in the Annals of Surgery, found that surgical ergonomic education was only formally provided in 1.5% of programs. Informal programs, which included the odd workshop or lecture, were more commonly reported, but only by 25.4% of surveyed program directors.

Best Practices in Surgical Ergonomics

Although formal guidelines for surgical ergonomics do not exist, the authors of the PLOS One study were able to generalize that sitting was better than standing across surgery specialties, and that two-minute breaks every 20 to 40 minutes could alleviate some level of surgery-related discomfort.