ERGO (ERGonomics in the Operating room) study: A cross-sectional international online survey

Abstract

Introduction: Although work-related physical disorders among surgeons are increasing globally, with potential detrimental effects on surgical performance and patient care, ergonomics is still overlooked in clinical practice. The aim of this study is to investigate ergonomics problems and perceptions in the operating room in an international cohort of surgeons to obtain baseline data necessary to plan implementation initiatives.

Methods: A Checklist for Reporting Results of Internet E-Surveys (CHERRIES)-compliant internet-based survey was developed using Google Forms and distributed via surgical societies, professional associations, and collaborative networks between September 2023 and February 2024 to surgeons from different specialties worldwide. The survey consisted of 6 sections, exploring various aspects such as job history, surgical specialty, practice location and role, surgical training, and injuries related to surgical practice. A total of 1,093 responses were received from surgeons in 42 countries. Because of the open distribution model, a precise response rate could not be calculated. The decision to use an online survey as the primary data collection method was driven by several distinct advantages. Primarily, this approach facilitated access to a broad and heterogeneous sample of surgeons encompassing various specialties and geographic locations-an achievement challenging to replicate with conventional survey techniques. The digital format enabled efficient dissemination through established channels, including surgical societies, professional organizations, and collaborative networks, thereby ensuring extensive reach in a cost-effective and timely fashion. Moreover, the anonymity afforded by the online platform encouraged participants to provide honest and uninhibited responses concerning sensitive topics such as musculoskeletal discomfort and ergonomic behaviors, mitigating potential biases linked to social desirability or fear of professional consequences. The flexibility inherent to an internet-based survey also allowed respondents to participate at their convenience, which likely enhanced overall response rates and engagement among busy health care professionals worldwide. Collectively, these attributes positioned the online survey as an optimal and practical tool for capturing comprehensive baseline data on ergonomic issues within the international surgical community.

Results: The survey received a total of 1,093 responses. Up to 96.9% of surgeons reported experiencing some musculoskeletal discomfort, which were more commonly associated with laparoscopy (55.4%), followed by open surgery (32.9%). Robotic surgery had the lowest rate of pain (1.1%, P < .001). Surgery-related injuries in 9.7% of cases prevented the surgeon from performing clinical or surgical duties, and in 13.4% of cases musculoskeletal pain necessitated absence from work or job leave. Overall, 31.4% of the respondents implemented risk mitigation strategies in the operating room with microbreaks and intraoperative stretching. Seventy-three percent of the responders have never followed formal training, lectures, or discussions about ergonomics.

Conclusion: Laparoscopic surgery significantly impacts surgeons; to mitigate the effects of musculoskeletal disorders on individual surgeons and the broader surgical workforce, innovations such as robotic surgery and ergonomic education may offer potential benefits; these descriptive findings highlight the need for further research to evaluate their role in reducing the burden of work-related musculoskeletal issues.