Presentation
HE19 - Surgeons’ Neuromusculoskeletal Disorders Based on Electronic Medical Records: Study Approach and Preliminary Results
SessionPoster Session 2
DescriptionAdvances in surgical technology and technique have improved patient outcomes and allowed for more complex, minimally invasive procedures. Despite these innovations, the prevalence of neuromusculoskeletal disorders (NMSDs), pain, and physical discomfort reported by surgeons has increased in the past decade (Epstein et al., 2018; Stucky et al., 2018). This “impending epidemic” (Park et al., 2010) negatively affects surgeon wellbeing, daily life (e.g., sleep) (Wohlauer et al., 2021), and career longevity and productivity. Previous studies have demonstrated almost 50% of surveyed surgeons feel that physical discomfort could negatively impact surgery performance and restrict career longevity (Wells et al., 2019; Wohlauer et al., 2021).
While there are several studies that have investigated surgeons’ self-reported NMSDs based on surveys (e.g., Norasi et al.; 2024, Norasi et al.; 2023, Epstein et al., 2018; Stucky et al., 2018), to the best of our knowledge there is no previous studies that has employed objective approaches such as exploring surgeons’ electronic medical records (EMR). The limitations of survey studies (e.g., recall bias, recency bias, skewed sample) are well-known; however, the challenges and complications of studying surgeons NMSDs based on their EMRs may have refrained the researchers to follow this approach. Surgeons physical and mental health is a key factor in their ability to perform surgical procedures and hospital systems and surgeons are very protective of information related to their health. However, NMSDs is a prevalent problem among surgeons and the first step in addressing this issue is to understand it in depth, which cannot be achieved solely based on survey studies. Thus, this study explores a research approach to investigate surgeons’ NMSDs based on their EMRs while protecting their privacy through a safe data extraction strategy.
This study was approved by the Institutional Review Board (IRB) of an academic hospital. The inclusion criteria covered all urologic, gynecologic, thoracic, and general (including breast, colorectal, hepato-pancreato-biliary, and bariatric) surgeons across all geographically distinct parts of this academic hospital system in the United States. Our approach included two phases. In the first phase an electronic survey using Qualtrics (Qualtrics, Provo, UT) was sent to the surgeons. In this phase, surgical ergonomics was introduced to the surgeons which enhanced buy-in among surgeons, while it also provided a baseline data set to compare with surgeons’ NMSDs recorded in their EMRs. The findings of this phase have been published by Norasi et al., in 2023 and 2024.
The second phase of the study explored surgeons’ NMSDs based on their EMRs and required a new IRB approval, reconsenting surgeons and achieving their Health Insurance Portability and Accountability Act (HIPAA) approval. Our approach could be summarized in three topics. 1) IRB protocol: Several meetings were conducted including the main research team, a senior translational informatics analyst, an occupational medicine specialist, and an institutional senior IRB expert. While the main goal was to ensure that all national and institutional regulations were observed in the IRB research protocol, all potential barriers and facilitators in enhancing buy-in among surgeons (participants) were also discussed. 2) Protecting participants’ privacy through a safe data extraction strategy: International Classification of Diseases, Tenth Revision (ICD-10) codes would be reviewed and filtered by the occupational medicine specialist to include all potentially work-related musculoskeletal disorders (e.g., carpal tunnel syndrome) and pain-related sleep disorders (e.g., pain-related insomnia). No mental health related issues (e.g., substance use/abuse), sexual health issues (e.g., sexual health disorders/infections), or sensitive sleep disorder issues (e.g., narcolepsy) would be included in the list of ICD-10 codes. Additionally, the consented surgeons’ full name, email address and year of birth would be collected. The senior translational informatics analyst would be responsible for extracting the ICD-10 codes from the hospital EPIC resources within the past 10 years. Then, she would filter the data by matching it with the participants’ name and year of birth. Finally, she would match the ICD-10 codes with the survey data from Phase 1. All the matched ICD-10 codes and survey data would then be deidentified by the senior translational informatics analyst and all the identifiable data would be destroyed to protect participants’ privacy. 3) Enhancing buy-in: A gadget of several methods was designed and employed to increase surgeons’ participation in the study. This multifaceted strategy included sending an invitation email to all surgeons in the hospital who satisfied the inclusion criteria. The email briefly described the study with a link to the first phase survey if they had not completed it, and links to the consented and HIPAA forms. Two additional follow-up emails were also sent with a gap of three weeks between each round. Also, a group of champion surgeons who had shown interest in ergonomics throughout our previous research studies were contacted directly to create the core of first participants. Additionally, flyers and posters were installed in the surgeons’ lounges and locker rooms where the operating rooms were located, and the study was also introduced in the Department of Surgery Newsletter. Furthermore, the research leaders scheduled and conducted several Grand Rounds as well as presentations at weekly and monthly meetings of surgical divisions and departments. Finally, a secondary list of champion surgeons was created, and one-on-one face-to-face and virtual meetings were scheduled to enhance participation in the study.
Out of 263 eligible surgeons, 58 surgeons participated, which led to a response rate of 22.1%. While recruiting participants is an ongoing process, the extracted data from the 58 surgeons showed that 34 of them (58.6%) reported at least one NMSD (31 participants) and/or a sleep disorder (5 participants). For each participant, the diagnosed ICD-10 codes with one or multiple occurrences in a period less than 6 months was counted as a unique diagnosis per body part (hand, wrist, elbow, shoulder, neck, upper back, back, hip, knee, ankle). This led to 84 unique diagnosed NMSDs, which were stratified based on body region (upper extremities, spine, lower extremities). Statistical analysis using Chi-square test showed that the frequency of the unique diagnosed NMSDs was significantly different among body regions (p = 0.0107) where 41 cases were reported for upper extremities (46.1%), 22 cases for spine (24.7%), and 21 cases for lower extremities (23.6%). The unique diagnosed NMSDs were also categorized based on body parts. Similar statistical analysis revealed that the frequency of the unique diagnosed NMSDs was significantly different among body parts (p = 0.0002) including 19 shoulders cases (22.6%), 13 knee cases (15.5%), 12 back cases (14.3%), 11 wrist cases (13.1%), eight neck case (9.5%), seven hand cases (8.3%), seven ankle cases (8.3%), four elbow cases (4.8%), two upper back cases (2.4%), and a hip case (1.2%).
The primary goal of this study was to develop a research approach for investigating surgeons’ NMSDs based on their EMRs, while ensuring the privacy of both the surgeons and the hospital system through a secure data extraction strategy. With a response rate of 22.1% from 58 surgeons, this study represents a promising starting point, particularly as similar research has not been conducted previously due to privacy challenges. Although the details of the data and findings are not extensively discussed in this study, the results demonstrate the applicability of the proposed approach, which could be enhanced incrementally. While several survey studies have investigated surgeons' NMSDs, this research provides surgical ergonomists with a strategy to explore this issue more objectively, leading to a deeper understanding of the problem. Additionally, these data could facilitate a more accurate estimation of the time and costs associated with NMSDs for both surgeons and hospitals, which is not easily achievable through traditional survey methods.
The references will be provided per request.
While there are several studies that have investigated surgeons’ self-reported NMSDs based on surveys (e.g., Norasi et al.; 2024, Norasi et al.; 2023, Epstein et al., 2018; Stucky et al., 2018), to the best of our knowledge there is no previous studies that has employed objective approaches such as exploring surgeons’ electronic medical records (EMR). The limitations of survey studies (e.g., recall bias, recency bias, skewed sample) are well-known; however, the challenges and complications of studying surgeons NMSDs based on their EMRs may have refrained the researchers to follow this approach. Surgeons physical and mental health is a key factor in their ability to perform surgical procedures and hospital systems and surgeons are very protective of information related to their health. However, NMSDs is a prevalent problem among surgeons and the first step in addressing this issue is to understand it in depth, which cannot be achieved solely based on survey studies. Thus, this study explores a research approach to investigate surgeons’ NMSDs based on their EMRs while protecting their privacy through a safe data extraction strategy.
This study was approved by the Institutional Review Board (IRB) of an academic hospital. The inclusion criteria covered all urologic, gynecologic, thoracic, and general (including breast, colorectal, hepato-pancreato-biliary, and bariatric) surgeons across all geographically distinct parts of this academic hospital system in the United States. Our approach included two phases. In the first phase an electronic survey using Qualtrics (Qualtrics, Provo, UT) was sent to the surgeons. In this phase, surgical ergonomics was introduced to the surgeons which enhanced buy-in among surgeons, while it also provided a baseline data set to compare with surgeons’ NMSDs recorded in their EMRs. The findings of this phase have been published by Norasi et al., in 2023 and 2024.
The second phase of the study explored surgeons’ NMSDs based on their EMRs and required a new IRB approval, reconsenting surgeons and achieving their Health Insurance Portability and Accountability Act (HIPAA) approval. Our approach could be summarized in three topics. 1) IRB protocol: Several meetings were conducted including the main research team, a senior translational informatics analyst, an occupational medicine specialist, and an institutional senior IRB expert. While the main goal was to ensure that all national and institutional regulations were observed in the IRB research protocol, all potential barriers and facilitators in enhancing buy-in among surgeons (participants) were also discussed. 2) Protecting participants’ privacy through a safe data extraction strategy: International Classification of Diseases, Tenth Revision (ICD-10) codes would be reviewed and filtered by the occupational medicine specialist to include all potentially work-related musculoskeletal disorders (e.g., carpal tunnel syndrome) and pain-related sleep disorders (e.g., pain-related insomnia). No mental health related issues (e.g., substance use/abuse), sexual health issues (e.g., sexual health disorders/infections), or sensitive sleep disorder issues (e.g., narcolepsy) would be included in the list of ICD-10 codes. Additionally, the consented surgeons’ full name, email address and year of birth would be collected. The senior translational informatics analyst would be responsible for extracting the ICD-10 codes from the hospital EPIC resources within the past 10 years. Then, she would filter the data by matching it with the participants’ name and year of birth. Finally, she would match the ICD-10 codes with the survey data from Phase 1. All the matched ICD-10 codes and survey data would then be deidentified by the senior translational informatics analyst and all the identifiable data would be destroyed to protect participants’ privacy. 3) Enhancing buy-in: A gadget of several methods was designed and employed to increase surgeons’ participation in the study. This multifaceted strategy included sending an invitation email to all surgeons in the hospital who satisfied the inclusion criteria. The email briefly described the study with a link to the first phase survey if they had not completed it, and links to the consented and HIPAA forms. Two additional follow-up emails were also sent with a gap of three weeks between each round. Also, a group of champion surgeons who had shown interest in ergonomics throughout our previous research studies were contacted directly to create the core of first participants. Additionally, flyers and posters were installed in the surgeons’ lounges and locker rooms where the operating rooms were located, and the study was also introduced in the Department of Surgery Newsletter. Furthermore, the research leaders scheduled and conducted several Grand Rounds as well as presentations at weekly and monthly meetings of surgical divisions and departments. Finally, a secondary list of champion surgeons was created, and one-on-one face-to-face and virtual meetings were scheduled to enhance participation in the study.
Out of 263 eligible surgeons, 58 surgeons participated, which led to a response rate of 22.1%. While recruiting participants is an ongoing process, the extracted data from the 58 surgeons showed that 34 of them (58.6%) reported at least one NMSD (31 participants) and/or a sleep disorder (5 participants). For each participant, the diagnosed ICD-10 codes with one or multiple occurrences in a period less than 6 months was counted as a unique diagnosis per body part (hand, wrist, elbow, shoulder, neck, upper back, back, hip, knee, ankle). This led to 84 unique diagnosed NMSDs, which were stratified based on body region (upper extremities, spine, lower extremities). Statistical analysis using Chi-square test showed that the frequency of the unique diagnosed NMSDs was significantly different among body regions (p = 0.0107) where 41 cases were reported for upper extremities (46.1%), 22 cases for spine (24.7%), and 21 cases for lower extremities (23.6%). The unique diagnosed NMSDs were also categorized based on body parts. Similar statistical analysis revealed that the frequency of the unique diagnosed NMSDs was significantly different among body parts (p = 0.0002) including 19 shoulders cases (22.6%), 13 knee cases (15.5%), 12 back cases (14.3%), 11 wrist cases (13.1%), eight neck case (9.5%), seven hand cases (8.3%), seven ankle cases (8.3%), four elbow cases (4.8%), two upper back cases (2.4%), and a hip case (1.2%).
The primary goal of this study was to develop a research approach for investigating surgeons’ NMSDs based on their EMRs, while ensuring the privacy of both the surgeons and the hospital system through a secure data extraction strategy. With a response rate of 22.1% from 58 surgeons, this study represents a promising starting point, particularly as similar research has not been conducted previously due to privacy challenges. Although the details of the data and findings are not extensively discussed in this study, the results demonstrate the applicability of the proposed approach, which could be enhanced incrementally. While several survey studies have investigated surgeons' NMSDs, this research provides surgical ergonomists with a strategy to explore this issue more objectively, leading to a deeper understanding of the problem. Additionally, these data could facilitate a more accurate estimation of the time and costs associated with NMSDs for both surgeons and hospitals, which is not easily achievable through traditional survey methods.
The references will be provided per request.
Event Type
Poster Presentation
TimeTuesday, April 14:45pm - 6:15pm EDT
LocationFrontenac Foyer