Surgeons…Get Moving!

Get moving, surgeons! New work from Adrian Park, M.D., chair of the Department of Surgery at Anne Arundel Medical Center (AAMC), indicates that surgeons who periodically pause for 90 seconds to perform a series of stretches throughout an operation report less work-related discomfort and an improvement in physical performance and mental focus.

“The results are alarming with surgeons reporting pain at a level of 5 out of 10 following a routine day’s work in the operating room, ” said Dr. Park in the March 8, 2016 news release. “Injury from simply going to work is not acceptable—we need to create both low-tech and high-tech solutions for our surgeons and operating room teams.”

As indicated in the news release, “The study shows that regular breaks to change positions improve physical function and helps maintain mental focus—not only protecting the surgeon, but also potentially protecting his/her patients…. In 2010, Dr. Park led a study that showed almost 87% of laparoscopic surgeons experienced discomfort they attribute to performing the procedures. The results provided the groundwork for leaders in the surgical field, such as Dr. Park, to speak up and take action.”

“It seems obvious that stretching would help relieve any discomfort while performing surgery. But the act of pausing during surgery is not a widely accepted practice—we are trained to work until we finish the job, ” said Dr. Park. “This is a cultural shift in the way surgeons are trained.”

In this study by Dr. Park, participants performed a series of “targeted stretching micro breaks” (TSMB) every 20-40 minutes. The five highly structured exercises are available at the links below:

• neck flexion, extension and lateral rotation;
• backward shoulder rolls with chest stretch;
• upper back and hand stretch;
• low back flexion and extension with gluteus maximus squeezes; and
• forefoot and heel lifts for lower extremity and ankle stretches.

As noted in the news release, “Each stretch is designed to be done for 90 seconds while maintaining sterile technique. The results show the majority of participants (57%) using TSMB perceive improvements in physical performance while 30% relate the stretches to improved mental focus. Finally, 87% of participants wanted to incorporate TSMB in their operating rooms in the future.”

“While the impact of TSMB on patient safety remains to be defined, we know that addressing ergonomic risk will enhance surgeons’ productivity, well-being, and endurance, all factors in maximizing patient safety in the operating room, ” added Dr. Park.

The study was conducted in collaboration with researchers and surgeons from Mayo Clinic, University of Louisville and Carolinas Medical Center.

Dr. Park told OTW, “I have had a longtime interest in surgeon health and well being, particularly in the perioperative environment. I’ve been very aware that while providing for the best outcomes for our patients, we often compromise our own health and well being.”

“These fairly simple exercise breaks really did improve surgeon reported (surgery related) pain; they also improved their sense of mental alertness and operative performance.”

“We need to look at ways to optimize surgeons’’ intraoperative cognitive workloads along with improving their (physical) ergonomics. Also look at tailoring the TSMBs to the unique needs and requirements of individual surgeons (e.g., those with low back vs neck vs shoulder pain, or unique combinations thereof).”

“Most surgeons were skeptical at the outset of the study, even having consented to be subjects. By the end of the study 87% stated their intent to continue with the TSMBs. Very real culture shift!”

Asked how he might head a committee tasked with developing ideas to improve intraoperative cognitive workloads and physical ergonomics, Dr. Park noted, “It will be an iterative process building on ‘baby steps!’ It will involve harnessing current and yet to be developed technologies as well as making lower tech changes in the work flow and choreography of surgeons and the OR team.”