A majority of vascular surgeons are in pain after a day of operating—with open and endovascular surgery identified as the types of intervention causing the greatest level of suffering from work-related discomfort, according to a study recently published in the Journal of Vascular Surgery.
The findings were derived from a survey of Society for Vascular Surgery (SVS) members carried out on behalf of SVS Wellness Task Force. It found that after a full day of open surgery, a majority of the respondents were in a moderately strong amount of pain. Nearly 40% reported they were suffering from chronic pain.
Work-related pain has a tremendous economic and psychological impact on U.S. society, yet—despite the high mental workload, repetitive movements and physical exertion to manipulate tissue and devices that comes with the performance of surgery—few surveys of surgical specialists have been reported, the research team, led by Max Wohlauer, MD, assistant professor of vascular surgery at the University of Colorado School of Medicine in Aurora, et al, write.
The investigators hypothesized vascular surgeons—who routinely carry out a combination of open and endovascular surgery, as well as endovenous interventions—would have “unique ergonomic challenges.”
The survey was mailed to 2,910 SVS members and designed to identify the prevalence and severity of work-related pain and disability among respondents. Questions related to surgeon wellness were also asked. Pain was reported using the Borg CR-10 scale: (0=no pain, 2=weak, 3=moderate, 4=moderately strong, 5=strong, 10=extremely strong). Descriptive statistics and a univariate logistic regression model were developed to identify independent risk factors for the development of work-related pain and disability, the authors go on.
A total of 775 (26.6%) responded to the survey, with 39 retirees excluded. Those included had been in practice for 17.2 ± 11.6 years, with a mean age of 51.4 ±10.9 years, and 83.6% were male. The prevalence of obesity was 12.8%.
The researchers found that after a full day of open surgery, the average vascular surgeon is in a moderately strong amount of pain—with a mean pain score of 4.4 ± 2.3 on the scale. Seventy-six percent of the surgeons reported clinically relevant pain (≥3), and 22% noted very strong pain (7+). After a full day of endovascular surgery, a majority said they were in a moderately strong amount of pain (mean score 3.9 ± 2.4). Seventy percent of the surgeons performing endovascular cases had a clinically relevant pain level (≥3), with 18% reporting very strong pain (7+).
“There is a high prevalence of clinically significant pain associated with the performance of open, endovascular and endovenous procedures,” the authors explain. Surgeons performing endovenous procedures recorded the lowest pain scores (mean 2.0 ± 2.0).
Pain following open surgery is highest in the neck, and after endovascular surgery in the lower back, they discovered.
The investigators write: “Of note, 39.5% (291/736) of the entire cohort of vascular surgeons responding to the survey report they are currently suffering from chronic pain. Nearly one-quarter (23.4%) sought medical care for chronic pain (172/736), 5.7% missed work (42/736), 9.9% had an ergonomic evaluation (73/736), 10% requiring surgery and other procedures—including traction (72/736), 2% (15/736) sought short-term disability and 1% (7/736) sought long-term disability due to physical issues, and 1.2% report they are leaving surgery due to work-related pain (9/736).”
Further results demonstrated the pain surgeons suffered interferes with posture among 33% of respondents, sleep in 26%, reduces stamina in 20%, affects mobility in 18%, concentration in 13%, and interferes with relationships in 12%.
In the operating room, it impacts teaching in 15% of those who returned a survey, slows down the speed of an operation in 13%; up to 10% alter their surgical approach because of pain; and 8.3% needed to take time away from the operating room due to acute or chronic work-related pain or discomfort. Among the 39 retirees, 26% ended their careers due to physical disabilities resulting from work-related pain.
Meanwhile, high work-related physical discomfort was found to be significantly associated with burnout for all modes of vascular surgery: open, endovascular procedures and endovenous interventions (burnout vs. no burnout, p<0.0001).
Univariate analysis performed to identify risk factors for developing moderately strong pain or higher revealed that for endovascular surgery, obesity increased the risk of moderately strong pain by 60% (p=0.05). For every unit of body mass index increase above 30, performing endovascular surgery increased the risk by an additional 6% (p=0.01). Obesity was not an independent risk factor for developing pain from the performance open surgery or endovenous intervention, the researchers found.
In terms of how workload constitution impacted pain, the authors found that surgeons who spend greater than 50% of their case-mix performing open extremity surgery increased the risk of work-related pain more than 3-fold (p=0.02).
“Performing surgery is a true privilege,” the authors write. “This unique, rewarding opportunity comes at a price, with nearly 70% of vascular surgeons reporting significant pain after a day of operating. Forty percent have chronic pain.
“Altogether, more than 50% of the vascular surgeons answering the survey feel that physical discomfort will affect the longevity of their careers. This includes short-term and long-term disability due to physical issues, curtailing practice, or retiring early due to work-related pain. Work-related pain is shortening the careers of some vascular surgeons and reducing the productivity of others, which produces a negative impact on the surgical workforce.”
The investigators zeroed in on the ramifications of their findings, pointing to a series of strategies that can be used to reduce pain induced by performing surgery, including exercise, posture awareness, yoga, regular stretching, equipment adjustment, and taking microbreaks while operating.
“Addressing work-related pain serves to improve the lives and careers of vascular surgeons, and enhancing surgical longevity would help combat the current national workforce shortage in vascular surgery,” Wohlauer et al concluded.