Poster 389: Operating Through the Pain: Systematic Review of Musculoskeletal Pain and Injury Epidemiology Among Orthopedic Surgeons and Trainees

OBJECTIVES: Many orthopedic surgeons experience work-related injury and musculoskeletal symptoms. The culture of orthopedics lends itself to surgeons and trainees operating through such injuries, which may jeopardize the health of orthopedic surgeons and impact their ability to provide exemplary patient care. The objective of this study was to present a comprehensive synthesis of the literature pertaining to occupational injuries among orthopedic surgeons, with particular emphasis on characterizing the predominant causes, treatments, and reported outcomes associated with these injuries. METHODS: A systematic review of the English-language literature from PubMed, Embase, and Scopus was performed according to the PRISMA guidelines. All studies assessing MSK-injury/pain epidemiology, treatment, or outcomes among orthopedic surgeons and trainees were included. Studies primarily assessing ergonomics pertaining to specific manufacturers or devices were excluded. Reviews, meta- analyses, editorials and conference abstracts were excluded. RESULTS: The literature search yielded 719 abstracts, and a total of 11 articles were identified for inclusion. All included studies were survey-based. A total of 2153 orthopedic surgeons, fellows, and residents were surveyed across several subspecialties (Table 1). 1547 orthopedic surgeons and trainees (71.9%) reported present or past work-related or work-exacerbated musculoskeletal injury/pain (Table 2). Four studies reported the back as the most commonly injured body part (Table 2). Four studies reported pain scores (Table 2). Three studies noted a greater prevalence of acute pain/injury as compared to chronic pain/injury (Table 2). Seven studies investigated the treatment of musculoskeletal injury/pain among orthopedic surgeons and trainees, including surgical, non-surgical, and pharmacological interventions (Table 3). A total of 605 of 1054 injured orthopedic surgeons/trainees (57.4%) received some form of treatment for musculoskeletal pain/injury. However, only 305 of 1054 injured orthopedic surgeons and trainees (28.9%) took time off from work due to pain/injury. Three studies compared the incidence of musculoskeletal injury/pain by orthopedic subspecialty and found no difference between subspecialties (Table 4). One study compared injury/pain incidence by training level and found no difference. Seven studies compared injury/pain incidence by sex and found no difference (Table 4). Nine studies assessed injury/pain incidence by number of years in practice; five of these studies reported a statistically significant association, where a higher number of years in practice correlated positively with a higher incidence of musculoskeletal injury/pain (Table 4). CONCLUSIONS: Many orthopedic surgeons and trainees experience musculoskeletal pain/injury and work through these symptoms. Many surgeons believe their injury/pain will have a deleterious impact on surgical performance and patient care. Thus, hospitals and other administrative programs should consider assessing orthopedic surgeons’ physical health and encourage paid rest time or other treatment modalities to promote surgeon well-being and optimize patient outcomes.