Workload Differentiates Breast Surgical Procedures: NSM Associated with Higher Workload Demand than SSM.
Adult
Aged
Ergonomics
Fatigue
Female
Humans
Male
Mastectomy
/ methods
Mastectomy, Segmental
Mental Fatigue
Middle Aged
Musculoskeletal Pain
Neck
Nipples
Occupational Health
Operative Time
Organ Sparing Treatments
Posture
Skin
Surgeons
Surgical Oncology
Surveys and Questionnaires
Torso
Upper Extremity
Wearable Electronic Devices
Workload
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
May 2020
May 2020
Historique:
received:
09
10
2019
pubmed:
10
1
2020
medline:
31
12
2020
entrez:
10
1
2020
Statut:
ppublish
Résumé
Breast surgery has evolved with more focus on improving cosmetic outcomes, which requires increased operative time and technical complexity. Implications of these technical advances in surgery for the surgeon are unclear, but they may increase intraoperative demands, both mentally and physically. We prospectively evaluated mental and physical demand across breast surgery procedures, and compared surgeon ergonomic risk between nipple-sparing (NSM) and skin-sparing mastectomy (SSM) using subjective and objective measures. From May 2017 to July 2017, breast surgeons completed modified NASA-Task Load Index (TLX) workload surveys after cases. From January 2018 to July 2018, surgeons completed workload surveys and wore inertial measurement units to evaluate their postures during NSM and SSM cases. Mean angles of surgical postures, ergonomic risk, survey items, and patient factors were analyzed. Procedural duration was moderately related to surgeon frustration, mental and physical demand, and fatigue (p < 0.001). NSMs were rated 23% more physically demanding (M = 13.3, SD = 4.3) and demanded 28% more effort (M = 14.4, SD = 4.6) than SSMs (M = 10.8, SD = 4.7; M = 11.8, SD = 5.0). Incision type was a contributing factor in workload and procedural difficulty. Left arm mean angle was significantly greater for NSM (M = 30.1 degrees, SD = 6.6) than SSMs (M = 18.2 degrees, SD = 4.3). A higher musculoskeletal disorder risk score for the trunk was significantly associated with higher surgeon physical workload (p = 0.02). Nipple-sparing mastectomy required the highest surgeon-reported workload of all breast procedures, including physical demand and effort. Objective measures identified the surgeons' left upper arm as being at the greatest risk for a work-related musculoskeletal disorder, specifically from performing NSMs.
Sections du résumé
BACKGROUND
BACKGROUND
Breast surgery has evolved with more focus on improving cosmetic outcomes, which requires increased operative time and technical complexity. Implications of these technical advances in surgery for the surgeon are unclear, but they may increase intraoperative demands, both mentally and physically. We prospectively evaluated mental and physical demand across breast surgery procedures, and compared surgeon ergonomic risk between nipple-sparing (NSM) and skin-sparing mastectomy (SSM) using subjective and objective measures.
METHODS
METHODS
From May 2017 to July 2017, breast surgeons completed modified NASA-Task Load Index (TLX) workload surveys after cases. From January 2018 to July 2018, surgeons completed workload surveys and wore inertial measurement units to evaluate their postures during NSM and SSM cases. Mean angles of surgical postures, ergonomic risk, survey items, and patient factors were analyzed.
RESULTS
RESULTS
Procedural duration was moderately related to surgeon frustration, mental and physical demand, and fatigue (p < 0.001). NSMs were rated 23% more physically demanding (M = 13.3, SD = 4.3) and demanded 28% more effort (M = 14.4, SD = 4.6) than SSMs (M = 10.8, SD = 4.7; M = 11.8, SD = 5.0). Incision type was a contributing factor in workload and procedural difficulty. Left arm mean angle was significantly greater for NSM (M = 30.1 degrees, SD = 6.6) than SSMs (M = 18.2 degrees, SD = 4.3). A higher musculoskeletal disorder risk score for the trunk was significantly associated with higher surgeon physical workload (p = 0.02).
CONCLUSION
CONCLUSIONS
Nipple-sparing mastectomy required the highest surgeon-reported workload of all breast procedures, including physical demand and effort. Objective measures identified the surgeons' left upper arm as being at the greatest risk for a work-related musculoskeletal disorder, specifically from performing NSMs.
Identifiants
pubmed: 31916090
doi: 10.1245/s10434-019-08159-0
pii: 10.1245/s10434-019-08159-0
pmc: PMC7138769
doi:
Types de publication
Comparative Study
Journal Article
Observational Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
1318-1326Références
Simul Healthc. 2010 Oct;5(5):267-71
pubmed: 21330808
J Appl Biomech. 2017 Jul;33(3):227-232
pubmed: 27918696
Surg Endosc. 2016 Mar;30(3):1205-11
pubmed: 26194249
Ann Surg. 2017 Dec;266(6):905-920
pubmed: 28306646
Appl Ergon. 2019 Jul;78:277-285
pubmed: 29960648
JAMA Surg. 2018 Feb 21;153(2):e174947
pubmed: 29282463
Occup Environ Med. 2004 Oct;61(10):844-53
pubmed: 15377771
Surg Endosc. 2019 Mar;33(3):933-940
pubmed: 30456510
J Biomech. 2010 Jul 20;43(10):1983-8
pubmed: 20382385
J Vasc Surg. 2019 Sep;70(3):913-920.e2
pubmed: 31279532
Ann Surg Oncol. 2017 Oct;24(10):3024-3031
pubmed: 28766233
Ann Surg. 2017 Feb;265(2):340-346
pubmed: 28059962
Obes Surg. 2015 Dec;25(12):2451-6
pubmed: 26459432
IEEE Trans Biomed Eng. 2006 Jul;53(7):1346-56
pubmed: 16830938
World J Surg. 2011 Sep;35(9):1961-9
pubmed: 21597890
Appl Ergon. 1993 Apr;24(2):91-9
pubmed: 15676903
Appl Ergon. 2016 Jul;55:70-84
pubmed: 26995038
Ann Med Surg (Lond). 2018 Jan 09;27:1-8
pubmed: 29511535
Surg Endosc. 2017 Feb;31(2):516-526
pubmed: 27324334
Appl Ergon. 1987 Sep;18(3):233-7
pubmed: 15676628
Surg Endosc. 2012 Jun;26(6):1516-21
pubmed: 22350226
Ann Surg. 2020 May;271(5):906-912
pubmed: 30614878
Sensors (Basel). 2014 Jan 09;14(1):1057-72
pubmed: 24412901
Am J Surg. 2005 Jul;190(1):107-13
pubmed: 15972181
J Robot Surg. 2012 Mar;6(1):65-72
pubmed: 27637981
Female Pelvic Med Reconstr Surg. 2018 Jan/Feb;24(1):1-12
pubmed: 28914699
Surg Endosc. 2010 Feb;24(2):377-82
pubmed: 19536599
Arthritis Rheum. 2004 Oct;50(10):3314-22
pubmed: 15476229
Ann Surg. 2013 Feb;257(2):256-9
pubmed: 22824853
Appl Ergon. 2017 Apr;60:334-341
pubmed: 28166893
Gait Posture. 2016 Jan;43:65-9
pubmed: 26669954
Ann Surg. 2020 Apr;271(4):686-692
pubmed: 30247331