AB177. SOH25_AB_123. In the neck of time: assessment of the effects of maladaptive neck posturing in reconstructive microsurgeons using real-time ergonomic monitoring

Background: This study aims to explore the prevalence of neck pain amongst reconstructive microsurgeons, quantify the time spent in a maladaptive posture (neck flexed >30 degrees) during microsurgical free flap raise and inset, and lastly, to identify factors associated with symptomatic neck pain.

Methods: Reconstructive microsurgeons were prospectively recruited prior to microsurgical cases at the Department of Plastic & Reconstructive Surgery, Beaumont Hospital, Dublin. The lead surgeon wore the Upright Go 2 device to measure time spent >30 degrees in neck flexion during free flap raise and micro-anastomosis. Surgeon characteristics and procedural factors were collated and the impact on surgeon function was assessed using the Neck Disability Index (NDI) questionnaire.

Results: Eight surgeons performed 19 free-flap procedures during the study period. Time spent in >30 degrees neck flexion was 79.44% [standard deviation (SD) =11.88%] of total procedural time during flap raise (mean time =1.68 hours) compared to 6.5% (SD =10.3%) during micro-anastomosis (mean time =1.2 hours) (P<0.0001, Mann-Whitney U test). Older age correlated with a greater prevalence of neck pain (P=0.01) and more surgeries per week were correlated with neck pain in the preceding 7 days (P=0.02). Older surgeons were more likely to reduce work (P<0.001) and leisure (P<0.001) activities due to neck pain and were less likely to support (P<0.001) or use (P<0.001) biofeedback postural training.

Conclusions: Ergonomic maladaptive posturing was significant during free flap raises and raises significant concerns as an occupational hazard. Exploration of interventions is urgently required to mitigate long-term musculoskeletal dysfunction in microsurgeons.

Keywords: Ergonomics; microsurgery; musculoskeletal disorders; neck pain; surgeon posture