63. Prevalence of work-related musculoskeletal disorders among orthopedic surgeons: a systematic review and meta-analysis

BACKGROUND CONTEXT Many orthopedic surgeons experience work-related musculoskeletal disorders (WMSDs), commonly in the neck and back. The Centers for Disease Control defines WMSDs as disorders manifesting in the nerves, muscles, tendons, joints, spinal discs, and cartilage caused/exacerbated by the work environment or nature of the work. PURPOSE (1) To estimate prevalence of WMSDs in orthopedic surgeons. (2) To estimate the disability burden of WMSDs in orthopedic surgeons. (3) To evaluate the scope of orthopedic surgical ergonomic assessment and interventions. STUDY DESIGN/SETTING A systematic-review of the English language literature from Pubmed, Embase, and Scopus identified studies reporting WMSD estimates and ergonomic assessment in orthopedic surgeons. WMSD estimates were pooled using random-effects models and a descriptive synthesis of the orthopedic surgical ergonomics literature was presented. PATIENT SAMPLE Nineteen survey-based studies assessing WMSDs in 2974 orthopedic surgeons (mean age, 45 years; 82% male) were included for meta-analysis. OUTCOME MEASURES The primary outcome was the career prevalence of WMSDs among orthopedic surgeons. Secondary outcomes included the disability burden of WMSDs among orthopedic surgeons and interventions to improve orthopedic surgical ergonomics. METHODS A systematic review of the English-language literature from PubMed, Embase, and Scopus was performed in December 2022. All studies assessing WMSD prevalence, prevention, and outcomes among orthopedic surgeons were included. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines for systematic reviews and meta-analyses of observational studies were used. Outcomes were pooled by random-effects meta-analytic models. RESULTS The literature search yielded 5,603 abstracts, and 19 survey-based studies (3,466 physicians [mean age, 45 years; 82% male]) were included for meta-analysis, and 19 articles were included for descriptive synthesis. Of those surveyed, 73.8% (95% CI, 65.7%-81.9%) experienced WMSDs. By anatomical location, WMSDs were most commonly experienced in the forearm/wrist/hand (29.6% [955 of 3,273 surgeons], 95%CI: 25%-34.3%), back (36.5% [1,178 of 3,286 surgeons], 95%CI: 27.9%-45.0%), and neck (35.0% [1069 of 3275 surgeons], 95% CI:25.0%-45.0%). Fourteen studies investigated the treatment of musculoskeletal injury/pain. Of those with a work-related musculoskeletal disorder, 22.8% (358 of 1,489 surgeons, 95%CI: 17.3%-28.3%) required a leave of absence, practice restriction or modification, or early retirement, and 54.0% (1,020 of 1,742 surgeons, 95% CI: 42%-69%) received some form of treatment. Heterogeneity was considerable for all crude analyses (mean I2 = 93.7%). Nineteen studies assessed surgical ergonomics in orthopedic surgeons, with three of these studies assessing interventions to improve ergonomics. Two of these studies reported improved surgical ergonomics with robotic-assistance. CONCLUSIONS The prevalence and disability burden of WMSDs among orthopedic surgeons is observably high. Many orthopedic surgeons do not receive treatment for WMSDs and continue operating, which may adversely affect surgical skills and patient outcomes. The orthopedic surgical ergonomics literature is limited. Efforts must be made to promote ergonomics education and research in order to prevent WMSDs in orthopedic surgeons. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs. Many orthopedic surgeons experience work-related musculoskeletal disorders (WMSDs), commonly in the neck and back. The Centers for Disease Control defines WMSDs as disorders manifesting in the nerves, muscles, tendons, joints, spinal discs, and cartilage caused/exacerbated by the work environment or nature of the work. (1) To estimate prevalence of WMSDs in orthopedic surgeons. (2) To estimate the disability burden of WMSDs in orthopedic surgeons. (3) To evaluate the scope of orthopedic surgical ergonomic assessment and interventions. A systematic-review of the English language literature from Pubmed, Embase, and Scopus identified studies reporting WMSD estimates and ergonomic assessment in orthopedic surgeons. WMSD estimates were pooled using random-effects models and a descriptive synthesis of the orthopedic surgical ergonomics literature was presented. Nineteen survey-based studies assessing WMSDs in 2974 orthopedic surgeons (mean age, 45 years; 82% male) were included for meta-analysis. The primary outcome was the career prevalence of WMSDs among orthopedic surgeons. Secondary outcomes included the disability burden of WMSDs among orthopedic surgeons and interventions to improve orthopedic surgical ergonomics. A systematic review of the English-language literature from PubMed, Embase, and Scopus was performed in December 2022. All studies assessing WMSD prevalence, prevention, and outcomes among orthopedic surgeons were included. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines for systematic reviews and meta-analyses of observational studies were used. Outcomes were pooled by random-effects meta-analytic models. The literature search yielded 5,603 abstracts, and 19 survey-based studies (3,466 physicians [mean age, 45 years; 82% male]) were included for meta-analysis, and 19 articles were included for descriptive synthesis. Of those surveyed, 73.8% (95% CI, 65.7%-81.9%) experienced WMSDs. By anatomical location, WMSDs were most commonly experienced in the forearm/wrist/hand (29.6% [955 of 3,273 surgeons], 95%CI: 25%-34.3%), back (36.5% [1,178 of 3,286 surgeons], 95%CI: 27.9%-45.0%), and neck (35.0% [1069 of 3275 surgeons], 95% CI:25.0%-45.0%). Fourteen studies investigated the treatment of musculoskeletal injury/pain. Of those with a work-related musculoskeletal disorder, 22.8% (358 of 1,489 surgeons, 95%CI: 17.3%-28.3%) required a leave of absence, practice restriction or modification, or early retirement, and 54.0% (1,020 of 1,742 surgeons, 95% CI: 42%-69%) received some form of treatment. Heterogeneity was considerable for all crude analyses (mean I2 = 93.7%). Nineteen studies assessed surgical ergonomics in orthopedic surgeons, with three of these studies assessing interventions to improve ergonomics. Two of these studies reported improved surgical ergonomics with robotic-assistance. The prevalence and disability burden of WMSDs among orthopedic surgeons is observably high. Many orthopedic surgeons do not receive treatment for WMSDs and continue operating, which may adversely affect surgical skills and patient outcomes. The orthopedic surgical ergonomics literature is limited. Efforts must be made to promote ergonomics education and research in order to prevent WMSDs in orthopedic surgeons.