Bariatric Times

MAR 2018

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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16 Original Research Bariatric Times • March 2018 The Prevalence of Musculoskeletal Injuries in Bariatric Surgeons by SALMAN AL-SABAH, MD, MBA, FRCSC, FACS; ELIANA AL HADDAD, MD; and HARIS KHWAJA, MD Bariatric Times. 2018;15(3):16–19. ABSTRACT Background: As the popularity of bariatric surgery increases, efforts into improving its patient safety and decreasing its invasiveness have also been on the rise. However, with this shift toward minimal invasiveness, surgeon ergonomic constraints have been imposed, with a recent report showing a 73- to 88-percent prevalence of physical complaints in surgeons performing laparoscopic surgeries. Methods: A web-based survey was designed and sent out to bariatric surgeons around the world. Participants were queried about professional background, primary practice setting, and various issues related to bariatric surgeries and musculoskeletal (MSK) injuries. Results: There were 113 responses from surgeons from 34 countries around the world. Of the responses, 66 percent reported that they experienced discomfort/pain attributed to surgical reasons, causing their case load to decrease in 27.2 percent of the surgeons. The back was the most affected area in those performing open surgery, while shoulders and back were equally as affected in those performing laparoscopic surgery. For those performing robotic surgery, the neck was the most affected area, with 29.4 percent of the surgeons reporting that this pain affected their task accuracy/ surgical performance. A higher percentage of female surgeons reported pain in the neck, back, and shoulder area when performing laparoscopic procedures. Supine positioning of patients evoked more discomfort in the wrists, while the French position caused more discomfort in the back region. Only 57.7 percent sought medical treatment for their MSK problem, of which 6.35 percent had to undergo surgery for their issue—55.6 percent of those felt that the treatment resolved their problem. Conclusion: MSK injuries and pain are a common occurrence among the population of bariatric surgeons (66%) and has the ability to hinder performance at work. Therefore, it is important to investigate ways to improve ergonomics for these surgeons to improve quality of life. KEYWORDS Musculoskeletal injuries, bariatric, surgery, laparoscopic, surgeons INTRODUCTION Surgeons are known to be a unique group of healthcare professionals that are at a higher risk for the development of a range of work- related musculoskeletal (MSK) pains and injuries. MSK disorders are typically defined as musculoskeletal complaints, symptoms, or pain that reflect a number of conditions, such as neck pain, back pain, shoulder pain, limb pain, carpal tunnel syndrome, myofacial dysfunction syndrome, atypical facial pain, and so forth. 1 These could range from mild, infrequent symptoms, to severe and debilitating ones, 2 interfering with surgeons' daily activities. As the popularity of bariatric surgery increases, 3 efforts into improving its patient safety and decreasing its invasiveness have also been on the rise. However, with this shift toward minimal invasiveness, surgeon ergonomic constraints have been imposed, with recent reports showing a 73- to 88-percent prevalence of physical complaints in surgeons performing laparoscopic surgeries. 4–6 And while newer techniques in minimally invasive surgeries, such as natural orifice transluminal endoscopic surgery (NOTES) and single-incision laparoscopic surgery (SILS), have greater benefits for the patient, 7,8 they have been shown to increase the physical workload for the surgeon. 9–11 On the other hand, the recent emergence of robotic surgery might provide the surgeon with ergonomic benefits, allowing the surgeon to operate from a seated position, with more degrees of freedom for instrumental movement and three- dimensional vision. 12,13 Therefore, the physical posture of a bariatric surgeon while providing care to their patients ideally should be that all muscles are in a relaxed, well-balanced, and neutral position. Postures outside of this neutral position for a prolonged period, such as those experienced during surgery, are likely what cause the musculoskeletal discomfort experienced by this population of physicians. 14 We therefore conducted a study to explore the prevalence of MSK pain and injuries in bariatric surgeons from around the world, investigating possible factors contributing to these injuries. MATERIALS AND METHODS Survey. We developed an online, web-based survey adapted from the previously validated Nordic Musculoskeletal Questionnaire 15 using an online survey generator. Figure 1 shows a sample of the questionnaire. The survey was then sent out to bariatric surgeons around the world through multiple social media platforms. Participants were queried about professional background and demographics, primary practice setting, and various issues related to bariatric surgeries and MSK injuries. Demographics collected included sex, age, height, weight, years practicing, average hours in the operating room per week, glove size, and most commonly employed operating position. The sections of the survey included demographics, physician visits, bariatric surgery background data, bariatric procedures, revisional bariatric procedures, and discomfort and procedure duration. The symptom portion of the questionnaire inquired about the nine different anatomic regions used in the NMQ: neck, shoulders, elbows, wrists/ hands, upper back, lower back, hips/thighs, knees, and ankles/feet. FIGURE 1. A sample of the questionnaire sent out to surgeons

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