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Fig. 1 Prevalence of nonmusculoskeletal occupational injuries among surveyed orthopaedic surgeons
Courtesy of Ramakanth R. Yakkanti, MD

AAOS Now

Published 3/25/2022
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Rebecca Araujo

High Rates of Occupational Physical, Mental Injuries among Orthopaedic Surgeons

A large study of orthopaedic surgeons, investigated incidence of occupational physical and mental injuries according to subspecialty and other surgeon factors. Ramakanth R. Yakkanti, MD, from the department of orthopaedic surgery at the University of Miami Jackson Memorial Hospital, will present the findings at the AAOS 2022 Annual Meeting.

The researchers chose to investigate this issue after observation and discussion with fellow orthopaedic surgeons about the occupational injuries they “have sustained throughout their years in practice,” Dr. Yakkanti told AAOS Now, including the injuries they have personally sustained or have known of occurring among other colleagues. According to Dr. Yakkanti, “Our study shows that the occupational hazards may vary by subspecialty, gender, and years in practice.”

In their study, the authors listed numerous occupational risks to the physical and mental health of orthopaedic surgeons, “due to the use of tools, exertion of force in nonergonomic positions, manipulation of heavy limbs, noisy work environments, long hours of standing, and working under stressful conditions.”

Occupational injury is not limited to musculoskeletal (MSK) injury but also can include radiation exposure, sound injury, infection, and mental and emotional injury, he added.

The investigators sought to conduct a large-scale, comprehensive investigation of injuries among orthopaedic surgeons across the United States. “To our knowledge, this is the largest study available in the literature, evaluating a total number of 1,645 orthopaedic surgeons,” the authors commented.

The team developed an electronic survey, which was emailed to all current AAOS members in the United States between March and April 2021. The survey was made up of eight sections with questions on demographics, training and practice settings, MSK injuries, disabilities, oncologic injuries, infections, sound-induced injuries, and psychological and emotional health. All survey items were analyzed via descriptive statistics, with chi-squared tests and paired tests used when appropriate to identify associations between factors or frequency of injury.

The initial survey was sent to 23,370 AAOS members, and 1,645 (7.03 percent) successfully completed the survey. The average respondent age was 58 years, and most respondents (89.6 percent) were male.

The orthopaedic surgeons reported 2,702 total work-related MSK injuries. Eighteen percent of injuries required surgical treatment. Wrist and hand injuries were the most common, in 39.8 percent of surgeons. Neck injuries were the second most common injury (44.4 percent). Rehabilitation or medication as treatment for wrist/hand or neck injuries was needed in 18.2 percent and 21.8 percent, respectively. Among the surgeries for occupational injuries, 44.4 percent were due to neck injuries and 44.4 percent were due to knee injuries.

There was a 3.7 percent rate (n = 61) of applications for disability claims secondary to injuries sustained “as a direct result of providing treatment to a patient, at some point in their career.” Two-thirds of surgeons who filed a claim returned to work, but one-third reported early retirement resulting from injury.

The authors also noted a significant relationship between surgeon subspecialty and the rate of injury. For example, the rate of MSK pain and injury was 22.2 percent for general orthopaedic surgeons and 21.7 percent among adult reconstruction surgeons. Those specialties were significantly associated with injury compared with other specialties (P = 0.02).

Interestingly, “Orthopaedic oncologists had the highest overall rate of injury [including non-MSK injuries], followed by spine surgeons and joint replacement surgeons,” noted Dr. Yakkanti.

General orthopaedic surgeons also had the highest rate of disability claims (7.1 percent, P = 0.00001) among the subspecialties, followed by spine surgeons at 5.1 percent.

Orthopaedic surgeons also faced significant rates of non-MSK injuries (Fig. 1). Finger sticks were common, with 93.8 percent of surgeons experiencing a finger stick from a needle, 66 percent from an orthopaedic instrument, and 61.8 percent from bone. One-third of participants experienced hearing loss since beginning practice.

Regarding mental and emotional health, 35.8 percent of surgeons reported feeling socially isolated because of their careers. More than half of respondents (55.8 percent) reported feelings of psychological distress since starting practice, and 64.4 percent experienced burnout from work. Notably, women experienced significantly higher rates of burnout than men (73.5 percent versus 63.4 percent; P = 0.01).

Dr. Yakkanti commented that he and his team were surprised by the high rate of burnout among orthopaedic surgeons, as well as the high rate of cancer among respondents.

The findings of the study should be considered with several limitations in mind, including the majority male population and the risk of bias associated with survey studies. “It is a survey-based study, so inherent limitations exist, such as recall bias, possible overrepresentation of surgeons who had injuries, and a lack of a consistent completion of all questions by all respondents,” Dr. Yakkanti commented.

“This study captures the spectrum of occupational injuries that pose longitudinal risks to an orthopaedic surgeon’s physical and mental well-being,” the authors summarized. “Our hope is that this analysis on MSK injuries, oncologic injuries, needle-stick injuries, sound-induced injuries, and psychological and emotional health will help raise awareness among the orthopaedic and medical communities to reduce these risks.”

The study will be presented as Paper 724 on Friday at 4:10 p.m. in Room N228.

Dr. Yakkanti’s coauthors of “Spectrum and Prevalence of Occupational Injuries among Orthopaedic Surgeons” are Anil Sedani, MD; Alina Syros, BS; Amiethab Aiyer, MD; and Victor H. Hernandez, MD.

Rebecca Araujo is the associate editor of AAOS Now. She can be reached at raraujo@aaos.org.