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Study: Almost 40% of vascular surgeons report suffering chronic work-related pain

By Bryan Kay

A majority of vascular surgeons are in pain after a day of operating—with open and endovascular surgery identified as the type of intervention causing the greatest level of suffering, 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 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, first-named author Max Wohlauer, MD, assistant professor of vascular surgery at the University of Colorado School of Medicine in Aurora, et al write. The researchers 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, mailed to 2,910 SVS members, was 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, and 10=extremely strong). Descriptive statistics and a univariate logistic regression model were developed to identify independent risk factors for work-related pain.

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 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 a 0-10 scale. Some 76% 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). And 70% 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 report the lowest pain scores (mean 2.0 ± 2.0). Pain following open surgery is highest in the neck, and after endovascular surgery pain is highest in the lower back, they find.

“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 onequarter (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; 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),” the investigators add.

Further results from the survey demonstrated that 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 (OR), the pain affects 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 OR due to acute or chronic work-related pain or discomfort. Among the 39 retirees, 26% ended their careers due to physical disabilities from work-related pain.

Meanwhile, high work-related physical discomfort was found to be significantly associated with burnout for open surgery as well as endovascular and endovenous procedures (burnout vs. no burnout, p<0.0001).

Risk factors

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 performing open surgery or endovenous intervention, the researchers found. In terms of how workload constitution impacted pain, the authors found that surgeons who spend more than 50% of their case-mix performing open extremity surgery increased the risk of work-related pain threefold-plus (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.”

They cite a series of strategies that can be used to reduce pain induced by performing surgery, including exercise, posture awareness, yoga and micro-breaks.