Orthopedic Surgery is Dangerous…for the Surgeon!

Is the surgeon injury situation improving? No.

Injury rates seem to be steady or, if the number of recent studies dedicated to the subject of physician injuries is any indication, growing worse. A meta-study published in 2018, “Prevalence of Work-Related Musculoskeletal Disorders Among Surgeons and Interventionalists – A Systematic Review and Meta-analysis,” showed somewhat less dramatic, but still shocking injury rates for all surgeons (suggesting that possibly scoliosis surgeons face greater hazard of injury). Of 5,828 surgeons in 21 articles, the pooled crude prevalence estimates of injuries and pathologies were:

• 17% (457 of 2406) suffered degenerative cervical spine disease;
• 18% (300 of 1513) had rotator cuff pathology;
• 19% (544 of 2449) had degenerative lumbar spine disease;
• 9&% (256 of 2449) had carpal tunnel syndrome.

The “Prevalence” study concluded that injury rates have been growing over the years, and that injuries are cutting into surgeons’ careers, both in days away from work and early, injury-related retirement: “From 1997 to 2015, the prevalence of degenerative cervical spine disease and degenerative lumbar spine disease increased by 18.3% and 27%, respectively. Pooled prevalence estimates for pain ranged from 35% to 60% and differed by assessment instrument.”

Of those with a work-related musculoskeletal disease, “12% (277 of 2319) required a leave of absence, practice restriction or modification, or early retirement,” that JAMA Network study reported.

It’s a worldwide surgeon injury epidemic.

A search of Google Scholar with these keywords, “prevalence of musculoskeletal injuries in orthopedic surgeons,” reveals several more U.S. studies published in 2018—and reveals that it’s not just happening here. That one search of a few Scholar pages turned up similarly dire surgeon injury reports from Canada, India, Italy, Korea, Kuwait, Norway, Poland, and Saudi Arabia in 2018, Iran in 2017, and the United Kingdom in 2014.

Nor are orthopedic surgeons the only victims: recent studies say dentists, bariatric, heart, and plastic and reconstructive surgeons are vulnerable as well. Two 2010 studies added laparoscopic surgeons to this list.

Another study, “Work-Related Musculoskeletal Discomfort and Injury in Microsurgeons,” says that microsurgeons who use loupes and microscopes to see what they’re doing are at high risk of a certain range of injuries and pathologies.

Here are some of its numbers: “Half of the surgeons reported pain within 4 hours of surgery, and 57% feared that pain would influence future surgical performance. Surgeon discomfort affected posture (72%), stamina (36%), sleep (29%), relationships (25%), concentration (22%), and surgical speed (19%). Tremor caused by the discomfort occurred in 8%. Medical treatment for discomfort was sought by 29%. Time off work for treatment occurred for 8%.”

Spine surgeons face those risks as well. Dr. Lonner told us that bending over a loupe to see three-dimensionally into a spine is a common source of back pain in scoliosis surgery.

However, the intense, forceful interventions needed for some orthopedic specialties seem to put these surgeons at higher risk than all but dentists, and … veterinary surgeons. They experience the same musculoskeletal issues as orthopedists—but surgeons with human patients are usually spared the bites and scratches reported as veterinary hazards in a 2009 Australian study that popped up in one of our searches.