Stretch Breaks During Surgery

Surgeons who pause during procedures to run through a series of stretches are more likely to avoid common ergonomic injuries and enjoy increased mental focus, according to a recent study published in the Annals of Surgery.

The study involved 63 surgeons who participated in 193 procedures without targeted stretching breaks, and 148 procedures with intraoperative targeted stretching micro breaks (TSMBs) performed every 20 to 40 minutes that included:

  • neck flexion, extension and lateral rotation;
  • backward shoulder rolls with chest stretches;
  • upper back and hand stretches;
  • low back flexion and extension with gluteus maximus squeezes; and
  • forefront and heel lifts for lower extremity and ankle stretches.

Surgeons who took TSMBs reported less pain in the neck, lower back, shoulders, upper back, wrist, hands, knees and ankles. More than half of the surgeons who stretched reported improved physical performance, one-third said they were able to focus better on the task at hand and a majority wanted to incorporate the stretching regimen into their surgical routines.

"The results are alarming with surgeons reporting pain at a level of 5 out of 10 following a routine day's work in the operating room," says study lead author Adrian Park, MD, chair of the department of surgery at Anne Arundel Medical Center in Annapolis, Md. "Injury from simply going to work is not acceptable — we need to create both low-tech and high-tech solutions for our surgeons and operating room teams.

The study notes that 87% of surgeons suffer from work-related pain and 40% burn out due to the physical and mental demands of the job. As surgeries become more complex and workloads increase, the risks of both will increase, say the researchers.

Says Dr. Park, "While the impact of targeted stretching micro breaks on patient safety remains to be defined, we know that addressing ergonomic risk will enhance surgeons' productivity, well-being, and endurance, all factors in maximizing patient safety in the operating room."

Daniel Cook

For Total Hips, No Need to Choose Sides

In the back-and-forth discussion about which is the better approach for total hips — direct anterior or posterior — there may finally be a definitive answer: neither. A study presented at the recent annual meeting of the American Academy of Orthopaedic Surgeons found no significant differences between the two approaches, based on patient-reported outcome measures at 6 months.

The study looked at 274 patients (137 matched pairs) who had hips replaced between June 2012 and August 2014. Half were done by surgeons who exclusively used the direct anterior approach; the other half were with surgeons who exclusively used the posterior approach. The average patient age was 65, and the average BMI was 28.

Researchers compared pre- and post-surgical pain, function in daily living, function in sports and recreation, hip-related quality of life and other symptoms, and found no real differences. "Both approaches yield excellent, equivalent results," says lead study author Mike Cremins, PhD, PA-C.

Jim Burger

Are Stem Cells the Future of Cataract Treatment?

Cataract surgery that uses a patient's own stem cells may be able to restore vision better than standard surgical treatments, according to a new study.

Writing in the journal Nature, researchers say that they successfully treated 12 human infants suffering from congenital cataracts by using a less-invasive surgical technique that encourages the regeneration of a new lens. The method resulted in fewer surgical complications and superior visual function when compared with traditional cataract surgery.

In the new treatment, the surgeon removes the patient's damaged lens while keeping its supportive capsule bag intact. This encourages the patient's natural stem cells to repopulate the area and grow a new, healthy lens.

In the study, patients who'd received traditional cataract surgery showed a higher incidence of post-op inflammation, early-onset ocular hypertension and increased lens clouding, while all of the patients who received the experimental treatment had a healthy, regenerated lens in their eye after 3 months.

Lead author Kang Zhang, MD, PhD, and his colleagues say that they hope to expand this research to see if the technique can be used to treat age-related cataracts, since many patients are left with suboptimal vision after standard surgery. "We believe that our new approach will result in a paradigm shift in cataract surgery and may offer patients a safer and better treatment option in the future," says Dr. Zhang.

Kendal Gapinski

InstaPoll: Do Your OR and SPD Get Along?

The working relationship between the OR and the sterile processing department is vital to the success of a facility's surgical services. It's also the most likely to be strained. Rate how well your OR and SPD get along in this week's InstaPoll, then check back next week for the results.

The next President of the United States is … Donald Trump, according to last week's poll results. Mr. Trump received 37% of the vote from our 545 respondents, compared to 33% for Democratic frontrunner Hillary Clinton. The results:

Who will be our next President?

  • Ted Cruz 18%
  • Marco Rubio 4%
  • Donald Trump 37%
  • Hillary Clinton 33%
  • Bernie Sanders 4%

Dan O'Connor

News & Notes
  • To err is human Automated infusion pumps were designed with patient safety in mind, but they won't prevent medication errors if their operators don't stick to clinical practices and deviate from hospital policy, says a recent multi-center study published online by BMJ Quality & Safety. The study found that 60% of IV drug administrations involved errors, the majority of which were labeling and tubing change infractions, but which also included delivering drugs at the wrong rate or without authorization.
  • Twins test anesthesia's effects Danish researchers who examined over 8,500 middle-aged and elderly twins — pairs in which one had undergone surgery with general anesthesia and one had not — have found no significant links between major procedures with inhalational agents and long-term cognitive decline. Reporting their findings in the journal Anesthesiology, they pointed instead to patients' pre-surgical mental abilities and health conditions as determining factors for cognitive impairment.
  • Against Connecticut's 6% ASC tax Connecticut lawmakers have introduced legislation that would repeal the 6% tax on services provided by the state's ASCs. Critics contend that the tax, which took effect on October 1 last year, could create financial hardships for many centers and impact patients' access to care.