Being a Surgeon Can Be Dangerous to Your Health

NEW YORK (Reuters Health) – In a survey of occupational injuries in oncologic surgeons at the University of Texas MD Anderson Cancer Center, 90{d3f6bf636dd0cfcc6b6abf6b418bf47c67e9ef114d0af9c178a3c3b139ba13ad} of the surgeons reported musculoskeletal symptoms and 28{d3f6bf636dd0cfcc6b6abf6b418bf47c67e9ef114d0af9c178a3c3b139ba13ad} reported an injury or condition attributed to operating, most of which required some form of treatment.

Based on responses from 127 of 219 surgeons invited to participate in the survey, the most common symptoms were fatigue, discomfort, stiffness, and back pain.

Of the 27.6{d3f6bf636dd0cfcc6b6abf6b418bf47c67e9ef114d0af9c178a3c3b139ba13ad} who reported an occupational injury, 65.7{d3f6bf636dd0cfcc6b6abf6b418bf47c67e9ef114d0af9c178a3c3b139ba13ad} received treatment, according to Dr. Rachel K. Voss, now at the UC San Diego Medical Center, and colleagues. More than a sixth of those treated required surgery for their injury, the researchers note in the Journal of the American College of Surgeons, online September 29.

The team also conducted a two-day randomized cross-over pilot study of intraoperative foot mat use. The use of anti-fatigue mats is recommended by the Occupational Safety and Health Administration (OSHA) to help prevent trauma and pain in the lower extremities in operating rooms.

Of the 20 surgeons who took part in the ergonomic intervention, 65{d3f6bf636dd0cfcc6b6abf6b418bf47c67e9ef114d0af9c178a3c3b139ba13ad} liked the experience and said they would use the mat again; 70{d3f6bf636dd0cfcc6b6abf6b418bf47c67e9ef114d0af9c178a3c3b139ba13ad} said they would recommend the mat to a colleague and 45{d3f6bf636dd0cfcc6b6abf6b418bf47c67e9ef114d0af9c178a3c3b139ba13ad} said it helped reduce surgery-related symptoms.

“Mat use was, however, statistically significantly associated with increased discomfort, with an associated wide confidence interval,” the researchers write in their report.

“Interestingly,” Dr. Voss told Reuters Health by email, “the majority of surgeons said they would use the mat again despite no statistical evidence for symptom improvement. It is important to know however that some individuals did report symptom improvement with the mat even if the group as a whole did not appear to benefit. Foot mats may benefit some individuals but are certainly not a ‘magic bullet’ for improving occupational symptoms.”

In general, Dr. Voss said her “perception is that surgeons have been operating with pain and discomfort and experiencing occupation-related injury for years in relative silence. We need to do better for our own health and for our patients.”

“Institutions and employers could make ergonomic and policy improvements to protect the health of surgeons but initiatives would be more successful with surgeon involvement,” she added. “Surgeons need to engage in better dialogue with occupational hygiene experts and industry experts to push for change. Of course, more research is needed, but being open to changes in the operating room environment and not settling for occupation-related symptoms and injuries is the first step.”

Dr. Voss said that “a surprise finding was that men were more likely to report an injury or chronic condition attributed to operating than women, contrary to prior reports. Furthermore, the rate of injury did not seem to correspond to experiencing occupational symptoms.”

Dr. John Thayer, chief of cardiothoracic surgery at St. Francis Hospital and Medical Center in Hartford, Connecticut, told Reuters Health by email that the “study raises an important issue that is not usually discussed among surgeons.”

“The study points out that over 90{d3f6bf636dd0cfcc6b6abf6b418bf47c67e9ef114d0af9c178a3c3b139ba13ad} of oncologic surgeons experience musculoskeletal discomfort due to the ergonomic hazards associated with operating,” said Dr. Thayer, who was not involved in the research.

“This is an important topic and emphasizes the need for more study and training in ergonomics as applied to the operating room,” he added. “It also reinforces the need for the surgeon to maintain fitness and flexibility despite demanding operative schedules.”

SOURCE: http://bit.ly/2epXIbl

J Am Coll Surg 2016.

US Surgeons Set Guidelines for Proper Attire Both In and Out of OR

The American College of Surgeons (ACS) has issued a statement on proper dress for surgeons, whether in the operating room or interacting with families or the public outside.

ACS Executive Director David B. Hoyt, MD, said the refresher statement is meant to provide evidence-based consensus on appropriate head coverings and when scrubs must be changed.

“Our fellows were concerned they were being told to do things that weren’t necessarily evidence-based,” he told Medscape Medical News. “It just was time for us all to take a step back and say what’s the best evidence, what’s best practice, and let’s all recommit to it.”

The statement was published online August 4 and will appear in the Bulletin of the American College of Surgeons in October.

Guidelines include:

• Change soiled scrubs and/or hats as soon as possible after surgery, and certainly before speaking with family members.
• Change scrubs and hats after contaminated cases, even if clothing is not visibly soiled. Discard paper skull caps at least daily and after every dirty or contaminated case. “Religious beliefs regarding headwear should be respected without compromising patient safety,” the authors explain.
• Do not let masks dangle.
• If wearing scrubs outside the operating room (OR), cover with a clean lab coat.
• Change out of scrubs before leaving the hospital. To enforce this, ACS recommends distinctive, colored scrubs for OR personnel. “I think there’s been a drift of wearing of scrubs into areas where you would not traditionally expect to see them,” Dr Hoyt said. “It does send a message other than that these are things worn for infection control and patient safety.”
• Remove or cover any jewelry on the head or neck that “might fall into or contaminate the sterile field,” before procedures, the authors recommend.
• Cover mouth, nose, and hair during invasive procedures. However, “There is no evidence that leaving ears, a limited amount of hair on the nape of the neck or a modest sideburn uncovered contributes to wound infections,” the guidelines authors write.
• Wear clean, appropriate professional attire (not scrubs) during all patient encounters outside the OR. “Physicians need to be reminded of these things, just like anybody else does,” Dr Hoyt said, although he acknowledged some will see it as one more set of rules to follow.

The authors of the guidelines also suggest clothing changes for all OR personnel, including anesthesiologists, certified nurse anesthetists, laboratory technicians, and aides.

The ACS is not the first organization to issue such guidelines. For instance, the Association of periOperative Registered Nurses updated their surgical attire guidelines in 2014 and included rules governing things such as cleaning protective eyewear, cellphones, and handheld devices and what shoes and shoe coverings are appropriate.

The Association of Surgical Technologists released their hand hygiene, surgical scrub, and surgical attire recommendations in 2008.

The guidelines do not add time to OR practice, and in fact support more flexibility in wearing some apparel, Dr Hoyt explained.

“What it doesn’t support is people getting in their car at night and driving in blood-soiled scrubs,” he said.

Dr Hoyt has disclosed no relevant financial relationships.

“Statement on Operating Room Attire.” ACS. Published online August 4, 2016. Full text

Physician Pleads Guilty to Torching Rival’s Office

Anthony Moschetto, DO, a cardiologist on Long Island, New York, had a business problem with a colleague-turned-rival.

It ended up in a court case that was anything but civil.

Dr Moschetto pleaded guilty in a New York State court last month to setting fire to the other physician’s office in Great Neck, New York, and conspiring to have him beaten up by a hireling, which never happened.

It was more complicated than that. Prosecutors said that a police investigation of illegal oxycodone prescriptions written by Dr Moschetto unexpectedly uncovered a murder-for-hire plot targeting an unnamed fellow cardiologist with whom Dr Moschetto had practised for 20 years. He vacillated between killing and merely assaulting the other physician before settling on the latter by the time of his arrest on April 14, 2015.

The ill will stemmed from an unspecified “professional dispute.”

“He wanted to put him out of business so he could get his business,” Nassau County Assistant District Attorney Anne Donnelly said at a press conference last year.

Dr Moschetto had enough tools at his disposal for all sorts of havoc. When police searched his mansion in Sands Points, New York, they found roughly 100 weapons, including rifles with illegal, high-capacity magazines, knives, and a grenade. Many of them were stored in a secret room behind a switch-activated moving bookshelf.

Dynamite, Fire, Fists

Dr Moschetto practised with the other cardiologist from 1994 until roughly 2 years ago. After the breakup, he originally wanted to dynamite the other physician’s office building, but switched to arson, according to prosecutors. The two men he hired for the job were only partly successful. The building’s sprinkler system put out the gasoline-fuelled fire before it had caused too much damage.

His next move was to attempt bodily harm. He offered an undercover detective $5000 to assault the other physician and, for a time, dangled $20,000 for a murder, going so far as to make down payments, prosecutors said.

Dr Moschetto pleaded guilty not only to arson and conspiracy to commit an assault but also to one count of illegal possession of a firearm and one count of the criminal sale of a prescription for a controlled substance. State prosecutors said the plea deal satisfied the original 77-count indictment against him.

His sentencing date is December 16. New York Supreme Court Justice Christopher Quinn intends to sentence him to 5 years in prison, according to prosecutors.

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