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Reduction of work-related musculoskeletal disorders in plastic surgeons via introduction of a posture-training device
Rachel M. Segal B.S.1, Michelle Zaldana-Flynn M.D.2, Riley Dean, M.D.2, Amanda A. Gosman, M.D.2, Chris M. Reid M.D.2 1 UC San Diego School of Medicine, San Diego, CA 2 Division of Plastic Surgery, Department of Surgery, UC San Diego San Diego, CA

Background: Plastic surgeons have an increased risk for the development of musculoskeletal disorders due to the poor ergonomics of the operating room. A sustained downward gaze is common during plastic surgical procedures, which can create a painful, non-anatomic loading force on the neck. The detrimental effect is compounded by the use of heavy surgical loupes or head lamps while operating. This study characterizes selected plastic surgery procedures, with an attempt to identify high-risk procedures and procedural components as well as the impact of biofeedback on surgical ergonomics.

Methods: A commercially available posture-training device was used to initially record neck and spine positioning and later to send biofeedback to prompt surgeons to correct posture (Figure 1). Device data was correlated with in-person observations to characterize factors associated with more time spent in the slouched/non-neutral cervical and thoracic spine posture.

Results: An analysis of variance (ANOVA) showed that proportion of time spent in the upright position during surgery yielded significant variation among male and female participants (p < 0.001), level of training (p < 0.001), participant height (p = 0.009), sitting vs. non-sitting positioning (p = 0.01), and loupes use (p = 0.04). Role in surgery, surgery subtype, and headlight use were not found to be statistically significant. There was a statistically significant difference in time spent in the upright/neutral cervical and thoracic spine position (mean = 0.70 +/- 0.285) if there was more than an eight-inch height differences between two participants compared to surgeries were there was not a large difference in height (mean = 0.854 +/- 0.172) (t(57) = 3.259, p = 0.02). Using the device intervention, all participants spent a larger proportion of operating time upright. Four of these participants (50.0%) experienced a statistically significant improvement in posture (p < 0.05). While in training mode, participants experienced shorter and more frequent periods of slouching/non-neutral posture. While in feedback mode, participants experienced shorter and more frequent periods of slouching/non-neutral posture. When comparing the same participant performing the same procedure with and without device biofeedback, 72.2% of participants spent more time in the upright/neutral posture during the surgery when the device was sending feedback (Figure 2).

Conclusion: Many surgeons experience negative health impacts due to the poor ergonomics of the operating room. Biofeedback devices utilized in the operating room can lead to improved surgical posture, which may translate to reduction of workplace injuries, and overall physician health. This study found that a commercially available posture-training device and sitting stools in the operating room could significantly improve physician cervical and thoracic spine posture.


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