Elsevier

Journal of Surgical Research

Volume 189, Issue 2, 15 June 2014, Pages 207-212.e6
Journal of Surgical Research

Education
Musculoskeletal occupational injury among surgeons: effects for patients, providers, and institutions

https://doi.org/10.1016/j.jss.2014.03.013Get rights and content

Abstract

Background

The aim of this study was to determine the risk of occupational musculoskeletal injury during a surgeon's career and the effects of these injuries for patients, providers, and institutions. We hypothesized that surgeons have occupational injuries, which affect work performance.

Materials and methods

Electronic RedCAP surveys on workplace injury were distributed statewide via e-mail to the members of the Tennessee chapter of the American College of Surgeons. Descriptive statistics were used to analyze survey data.

Results

A total of 260 of 793 surveys (33%) were returned. Forty percent of surgeons sustained ≥1 injuries in the workplace. Although 50% of injured surgeons received medical care for their most recent injuries, only 20% of these injuries were reported to their institution. Twenty-two percent of injured surgeons missed work and 35% performed fewer operations while they were recovering from their injury. Fifty-three percent of injured surgeons reported that pain from their injury had a minimal or moderate effect on their performance in the operating room.

Conclusions

Surgeons appear to be at moderate risk for occupation-related injuries. The low rate of institutional reporting for these injuries is concerning, as this is a required step to access institutional support once injured. Surgeon injury results in lost productivity due to missed workdays and may impact the quality of surgical care because of performance issues while recovering from injury.

Introduction

Costs associated with occupational injury within the hospital industry exceed $190 billion annually, the third highest among 313 US industries [1], [2]. According to the Occupational Safety and Health Administration, “an occupational injury is any wound or damage to the body resulting from an event in the work environment. An injury is considered work-related if an event or exposure in the work environment either caused or contributed to the resulting condition or significantly aggravated a preexisting condition [3].” Studies of occupational injury within the hospital industry have focused primarily on direct care occupations such as nursing [4], [5]. Nursing aides, orderlies, and attendants have the second highest incidence of nonfatal occupational injuries leading to missed work among common US occupations, sustaining more injuries than construction and freight workers [6]. Despite the identification of the hospital environment as high risk for occupational injury, relatively little study has focused on the risk of occupational injuries among physicians or surgeons specifically.

The percentage of surgeons who regularly experience musculoskeletal symptoms in the workplace has varied between 50%–85% in recent surveys examining a broad array of surgical specialties [7], [8], [9], [10]. These studies and anecdotal evidence suggest that most surgeons have chronic musculoskeletal complaints at some point in their careers. The positions held by surgeons for extended hours in the operating room are known to increase risk for musculoskeletal injury [11], [12]. The modern surgical practice may increase risk for injury as laparoscopic procedures are being performed more often, and these techniques have been shown to increase risk of injury to the performing surgeon [13], [14]. Thus, surgeons have specific occupational risk factors while working in an environment known to have elevated risks of workplace injury.

This study examines the impact of surgeon injury on patients, providers, and institutions. Surgeon injury may impact patient outcomes by affecting the quality of surgical care provided or through physician shortage if unable to perform the usual caseload [15]. Surgeons are highly trained workers with immense personal and institutional investment in their ability to function at the highest level. Surgeon injury may also impact providers through workload reduction thereby threatening personal earning potential [10]. Institutional injury reporting is a required step in the access of resources such as rehabilitation and disability for individuals injured in the workplace [16]. Surgeon injury may impact institutions on several levels including lost revenue, risk of malpractice claims, and general morale of injured workers [17]. In this study, we report the results of a survey study examining occupational injury among American College of Surgeons (ACS) Fellows in Tennessee. We will attempt to identify the prevalence of occupational injury over the career of a surgeon and the impact of these injuries on patients, providers, and institutions.

Section snippets

Participants

We contacted 793 current members of the Tennessee Chapter of the ACS to answer an anonymous web-based survey. The invitation noted that the study would be used to examine the impact of musculoskeletal injuries in the workplace among the surgeon population. After obtaining permission from our institutional review board, the original invitation was sent on July 26, 2012. Reminder e-mails were sent bimonthly to request participation from nonrespondents, and data collection closed on January 5,

Results

Of 793 surgeons invited for participation in our survey, 260 (33%) successfully completed and returned the survey during the collection period. A total of 209 respondents (80%) were male, and the median body mass index of all respondents was 25.8 (Table 1). General surgery was the most commonly represented surgical specialty with 165 respondents (64%). Most of the 57 respondents (22%) indicating “other” for specialty represent general surgery specialties, such as cardiothoracic and vascular

Discussion

Surgeons appear to be at moderate risk for occupational injury. We identified lost productivity associated with surgeon occupational injury. Although most surgeons do not appear to miss work from injury, our study identified a significant minority (5%) of respondents that missed at least 2 wk of work from their most recent workplace injury. A survey of hospital Chief Financial Officers in 2010 found that a general surgeon on average generates more than $2.1 million in net revenue annually for a

Acknowledgment

Authors' contributions: W.T.D. and O.D.G. contributed to study conception and design, analysis and interpretation, data collection, and critical revision of the article. S.A.F. contributed to study design, analysis and interpretation.

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  • Cited by (0)

    This work was presented as a poster presentation at the 2013 American College of Surgeons Annual Clinical Congress in Washington, DC, October 6–10.

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