391reported the pain to their institution [ 49 ]. With these percentages in mind, the
high rate of injuries reported by the US Bureau of Labor Statistics, data collected
solely from institutional reporting, may be a gross underestimation of reality.
It is largely unknown why surgeons do not report their injuries. One study sug-
gests that 30% of surgeons do not know how to report an occupational injury [ 29 ]
and many may not see a need to report. Another possibility is that surgeons believe
an injury could impact his or her training or professional reputation. Alternatively,
while maintaining focus on patient care, surgeons may overlook their own well-
being, accepting pain as just another part of the job [ 13 ]. Regardless of the reason,
the low rate of reporting occupational injuries among surgeons is concerning as it
may represent a culture of silence. Culture change may be required to prevent fur-
ther repercussions to both provider and patient.
Consequences of Surgeon Musculoskeletal Pain
Surgeon musculoskeletal pain has theoretical downstream consequences, including
poor outcomes, lost revenue, and surgeon burnout. The impact of surgeon discom-
fort on patient outcomes has not yet been fully described. A surgeon distracted by
pain is unlikely to operate with maximum precision and focus. Over 50% of sur-
geons with musculoskeletal pain report that pain negatively affects their perfor-
mance in the operating room [ 39 , 40 , 51 ]. It has also been found that surgeon’s
symptoms may influence their choice of operative approach, some opting to per-
form open surgeries over laparoscopy [ 8 , 17 ].
Of those surgeons who report discomfort, approximately 25% have taken time
off work [ 34 , 51 – 53 ] with even more surgeons opting to decrease their operative
caseload [ 9 , 26 , 51 ]. When an injury results in leave from work, an average of
7.3 days is lost [ 49 ]. One week of lost work for a general surgeon results in the
loss of approximately $36,000 in hospital revenue, extrapolated from data pub-
lished by Merritt Hawkins in 2016 [ 54 ]. This is in addition to the surgeon’s own
loss in personal income. Further, some surgeons consider early retirement and
are concerned that pain will shorten their surgical careers [ 38 , 48 , 53 , 55 , 56 ].
This may have greater societal repercussions than lost revenue in an era already
anticipating a shortage of surgeons. With a projected shortfall of between 25,200
and 33,200 surgeons by 2025, increasing numbers of early retirements could
further exacerbate this situation and lead to patients without access to surgical
care [ 57 ].
For surgery residents, injury may have direct consequences on their training.
Training programs abide by rules put in place by the Accreditation Council for
Graduate Medical Education (ACGME) in regard to total weeks of training.
Residents are allowed 1 month of absence per year for illness, vacation, and other
reasons. Absence longer than 1 month may result in an extension of resident train-
ing time [ 58 ]. In a study of work-related injuries sustained during obstetrics and
gynecology training, Yoong et al. found that out of 97 residents, 28 (29%) had suf-
fered injuries at work. Eight respondents required time off from residency, and one
had to prolong training by 3 months [ 59 ].
22 Surgical Ergonomics