Surgeons Benefit From Short Intraoperative Stretching Breaks

February 29, 2016 NEW YORK (Reuters Health) - Targeted intraoperative stretching "micro-breaks" reduce surgeon fatigue, strain, and injury, researchers report. One of the major factors that shorten surgeons' careers is work-related pain, they note in a paper online February 10 in Annals of Surgery.

To evaluate the effect of targeted stretching micro-breaks, Dr. Adrian E. Park from Anne Arundel Medical Center in Annapolis and Johns Hopkins University School of Medicine in Baltimore, Maryland, and colleagues recruited 66 members of surgical teams for a multicenter crossover study.

"This study is important," said Dr. Park. "There's compelling evidence that surgeons are at risk of work-related injury at a rate that would be unacceptable in any other regulated or monitored job."

Of the participants, 61 were attending surgeons with a variety of specialties. They reported experiencing pain during surgery after an average operative time of 81 minutes; the region of greatest pain was the neck, followed by the lower back, shoulders, upper back, wrists/hands, knees, and ankles.

The standardized 1.5-minute targeted stretching micro-breaks at 20- to 40-minute intervals included five exercises: neck flexion, extension and lateral rotation; backward shoulder rolls with chest stretch; upper back and hand stretch; low back flexion and extension with gluteus maximus squeezes; and forefoot and heel lifts for lower extremity and ankle stretches.

Each stretch could be performed within 120 seconds while maintaining sterile technique. Participants completed a total of 341 surgeries, 148 with targeted stretching micro-breaks and 193 without. Mean operative time in the stretching group was 133 minutes versus 128 minutes in the non-stretching group (p=0.40). A comparison of pain scores before and after targeted stretching micro-breaks showed significant improvement in neck pain (p=0.01);

right and left shoulders (p<0.001); right and left hands (p=0.03); and upper and lower back (p=0.03).

According to Dr. Park, failure to address work-related pain and injuries goes beyond the effects on surgeons' stamina, focus, and well- being.

"The surgical workload is increasing in the U.S., but the surgical workforce is flat at best, and in some places, it's declining. This is not just a surgeon's problem," he said, "it's a public-health issue."

Dr. Park said that rather than making costly alterations to instrumentation or changes in the operating theatre, micro-break stretching is an easily implemented, practical, and cost-effective solution to work-related injuries.

"Micro-break stretching can reduce pain and increase surgeons' stamina, mental focus, and sense of performance," said Dr. Park, noting that it can also play a role in altering the operative flow and experience.

Dr. Daniel B. Jones, chief of minimally invasive surgery at Beth Israel Deaconess Medical Center in Boston, said findings such as the current ones are always useful to get surgeons to do what they already know to be true.

"There's nothing new to the message to get comfortable and take an occasional break to stretch," Dr. Jones, who was not involved in the study, told Reuters Health by email.

According to Dr. Jones, lots of small breaks are already part of a routine operation. However, he said, the deliberate pause and stretch before a key complex step is worth emphasizing.

"It brings clarity and focus to getting the task done exceptionally well," he said. SOURCE: Ann Surg 2016.

Reuters Health Information © 2016

Cite this article: Surgeons Benefit From Short Intraoperative Stretching Breaks. Medscape. Feb 26, 2016.