Sensors Provide Insights on High-Risk Positions During Surgery

Andrew Meltzer, MD, MBA

Wearable technology could serve as a means to assess a surgeon’s intraoperative ergonomics and postural behavior, according to the findings of a new study.

Andrew Meltzer, MD, MBA, and colleagues from Mayo Clinic used wearable sensor inertial measurement units to monitor the ergonomics of surgeons at work. Meltzer and the team aimed to identify injury risk factors and were able to determine which surgeries and positions put the specialists at the highest risk.

Meltzer, from the vascular surgery division at Mayo Clinic, and the team placed 4 inertial measurement units on more than 50 surgeons across 12 different specialties. The sensors, which measured body-posture angles via data from an accelerometer, magnetometer, and gyroscope, were placed on the surgeon’s head, torso, and upper arms to measure deviations from neutral body position.

The investigators defined high-classification risk based on occupational ergonomic research exposure-response analyses. Such research showed significant musculoskeletal disorders and discomfort associated with exposure to neck, torso, and arm postures in the high-risk categories.

Meltzer and the team compared ergonomic risk across procedure categories (open, laparoscopic, and endovascular surgeries), adjunctive equipment (loupes, headlight, and lead apron), and surgeon characteristics.

Overall, the investigators included 53 surgeons—19 women, mean age of 45 years old. The surgeons underwent continuous inertial measurement unit recording during 115 surgical cases. Surgeons spent 65% of procedure time in high-risk neck positions.

For the torso and neck, high-risk positions were observed during 30% and 11% of the procedure minutes. Open surgeries resulted in the highest postural neck risk compared to laparoscopic procedures (adjHR, 31.3; 95% CI, 8.47-114.41; P <.001).

Using surgical loupes and headlamps were both independently associated with increased time in unfavorable neck positions (mean with loupes, 85.2%; P <.001; without loupes, 58.1%; P <.007; with headlamps, 79.9%; without headlamps, 62.2%; P=.02).

Risk factors for reported pain included longer case length (P <.001), increased years in practice (P=.02), and use of loupes (P <.001) and headlamps (P=.01). Self-reported pain was linked with ergonomic risk (P <.01).

If a surgeon had poor ergonomics, they could be at an increased risk of chronic pain or disability. The risks could jeopardize the longevity of a surgeon’s career, thus affecting patients’ access to receiving surgical care.

The use of wearable technology offers insights on a surgeon’s intraoperative ergonomics and postural behavior, which could lead to adjustments in the way surgeons are performing specific surgical procedures.

Meltzer and the team concluded that further research was warranted with a larger sample size and that surgeons should be more mindful of their intraoperative techniques and ergonomics.

The study, “Measuring Ergonomic Risk in Operating Surgeons by Using Wearable Technology,” was published online in JAMA Surgery.