Orthopedic Surgery is Dangerous…for the Surgeon!

But where’s OSHA? What’s the government doing to help?

Hospital non-fatal injury rates are far higher than industry generally. Indeed, factories and other industrial businesses have cut their rates from 61 injuries per full-time work equivalents (FTEs) in 2000 to 2.9 injuries per 100 full-time equivalents (FTEs) in 2017. Compare those numbers with hospitals for these selected years:

1997: 10.0
2000: 9.1
2010: 6.5
2014: 6.2
2015: 6.0
2016: 5.5
2017: 5.3

The 2017 rate is still 83% higher than for workplaces overall, but it’s a 47% decrease in hospital worker injuries in two decades.

The Occupational Safety and Health Administration (OSHA) has a hospital microsite, dedicated to concerns about hospital “workers.” Everything about the language at that site suggests that the “workers” of concern to OSHA aren’t surgeons.

While OSHA goes about preventing injuries to other hospital workers, there is “Very little or no practical involvement with physician MS (musculoskeletal) overuse,” Dr. Lonner said in his presentation. At the OSHA microsite, none of the safety suggestions are specific to operating rooms. Some examples of OSHA’s concerns:

• “By implementing a minimal-lift policy and other safety initiatives, Cincinnati Children’s Hospital reduced lost time days by 83 percent in just three years.”
• “After investing $800,000 in a safe lifting program, Stanford University Medical Center saw a five-year net savings of $2.2 million. Roughly half of the savings came from workers’ compensation, and half from reducing pressure ulcers in patients.”
• “Tampa General Hospital’s lift teams have used mechanical lifting equipment to reduce patient handling injuries by 65 percent and associated costs by 92 percent.”
• “By implementing a safe handling program, a small hospital in South Carolina cut turnover of older nurses by 48 percent and saved $170,000 on associated costs.”

But nothing on how to address surgeon injuries.

What should be done?

The SRS presidents Dr. Lonner polled had these suggestions:

• Use power tools for screw placement and bone scalpeling.
• Avoid overhead bins when traveling so as not to lift overhead.
• Use fellows to assist.
• Allow more junior surgeons to do some of the operating grunt work.
• There’s a need for less weighty tools and batteries.
• Maintain general fitness/exercise (see below).
• Wear compression stockings for lower extremity edema and discomfort.
• Get treatment for your own orthopedic problems early.
• Education is needed.

Dr. Lonner suggests also using appropriately sized tools and ergonomic tools, such as screwdrivers which can be used at an angle, and new visualization techniques, including loupes and endoscopes with right-angle mirrors to see into the spine.

He cited a Duke University School of Medicine study which recommends:

• Adjust the height/position of the patient and operating table.
• Alternate postures by sitting when feasible.
• Select the most ergonomic equipment.