Background Long surgical procedures with loupe magnification and microscopes may put microsurgeons at an increased risk of musculoskeletal discomfort. Identifying the prevalence and impact of work-related musculoskeletal discomfort may guide preventive strategies to prolong well-being, job satisfaction, and career duration. Methods An online 29-question survey was designed to evaluate work-related musculoskeletal discomfort. The survey was created and distributed electronically through a private survey research center and was sent to the members of the American Society for Reconstructive Microsurgery. Results There were 117 respondents (16.7% response rate): 80% were men; 69% were aged 31 to 50 years; and 68% were in academic practice. On a scale of 0 to 10 (0, no pain and 10, worst pain), the median for work-related musculoskeletal discomfort for surgery without loupes or microscope was 2; with loupes, 4; and with a microscope, 5. Pain was most common in the neck. Half of the surgeons reported pain within 4 hours of surgery, and 57% feared that pain would influence future surgical performance. Surgeon discomfort affected posture (72%), stamina (36%), sleep (29%), relationships (25%), concentration (22%), and surgical speed (19%). Tremor caused by the discomfort occurred in 8%. Medical treatment for discomfort was sought by 29%. Time off work for treatment occurred for 8%. Conclusion Work-related musculoskeletal discomfort can affect many aspects of a microsurgeon's life and has the potential to limit a surgeon's ability to operate. Therefore, more emphasis is needed in the surgical community on the important issues of occupational health and surgical ergonomics for microsurgeons.

Introduction: Physician burnout has been linked to medical errors, decreased patient satisfaction, and decreased career longevity. In light of the increasing prevalence of cardiovascular disease, vascular surgeon burnout presents a legitimate public health concern owing to the impact on the adequacy of the vascular surgery workforce. The aims of this study were to define the prevalence of burnout among practicing vascular surgeons and identify factors that contribute to burnout to facilitate future Society for Vascular Surgery (SVS) initiatives to mitigate this crisis.Methods: In 2018, active SVS members were surveyed electronically and confidentially using the Maslach Burnout Inventory. The survey was tailored to explore specialty-specific issues, and to capture demographic and practice-related characteristics. Emotional exhaustion (EE) and depersonalization (DP) were analyzed as dimensions of burnout. Consistent with convention, surgeons with a high score on the DP and/or EE subscales of the Maslach Burnout Inventory were considered to have at least one manifestation of professional burnout. Risk factors associated with symptoms of burnout were identified using bivariate analyses (c 2 , Kruskal-Wallis). Multivariate logistic regression models were developed to identify independent risk factors for burnout.Results: Of 2905 active SVS members, 960 responded to the survey (34% participation rate). After excluding retired surgeons and incomplete submissions, responses from 872 practicing vascular surgeons were analyzed. The mean age was 49.7 6 11.0 years; the majority of respondents (81%) were male. Primary practice settings were academic (40%), community practice (41%), veteran's hospital (3.3%), active military practice (1.5%), or other. Years in practice averaged 15.7 6 11.7. Overall, 41% of respondents had at least one symptoms of burnout (ie, high EE and/or high DP), 37% endorsed symptoms of depression in the past month, and 8% indicated they had considered suicide in the last 12 months. In unadjusted analysis, factors significantly associated with burnout (P < .05) included clinical work hours, on-call frequency, electronic medical record and documentation requirements, work-home conflict, and work-related physical pain. On multivariate analysis, age, work-related physical pain and work-home conflict were independent predictors for burnout.Conclusions: Symptoms of burnout and depression are common among vascular surgeons. Advancing age, work-related physical pain, and work-home conflict are independent predictors for burnout among vascular surgeons. Efforts to promote vascular surgeon well-being must address specialty-specific challenges, including the high prevalence of workhome conflict and occupational factors that contribute to work-related pain.

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OCCUPATIONAL APPLICATIONS The application of ergonomics principles can reduce the number, severity, and costs of work-related musculoskeletal disorders. Increasingly, academic and practitioner research demonstrates that ergonomic improvements also contribute to manufacturing operating efficiency and a company's profitability. This article examines whether it is possible to identify business benefits achieved through ergonomics interventions via an ergonomics award process. The projects, conducted independently at numerous manufacturing locations and submitted to a global company's internal ergonomics award process, were reviewed for effect upon both work-related musculoskeletal disorders and operational efficiency. The results suggest the award process was successful in gathering relevant information about the projects, and that a macroergonomics program methodology along with a participatory approach supported successful results. A cost-benefit estimation showed positive effects in operational efficiency and work-related musculoskeletal disorders reduction. Possible improvements to the award submission process were identified.TECHNICAL ABSTRACT Background: As documented by academics and practitioners, and generally accepted by the popular media, application of ergonomics principles can reduce the number, severity, and costs of workrelated musculoskeletal disorders. Research increasingly demonstrates that ergonomic improvements also contribute to manufacturing operating efficiency and a company's profitability. Purpose: To expand the body of practitioner-based knowledge related to the benefits that may be realized through implementing an ergonomics program in industry, focusing on the physical aspects of work. Specifically considered is the importance of a macroergonomic, company-wide process to define how risk assessments are conducted, how interventions are chosen and measured, and how results are summarized. Method: Eighteen case studies, selected from among 166 submitted to a global manufacturing company's internal ergonomics award process were reviewed. Results: A macroergonomics program methodology, in combination with a participatory approach, supported success in terms of reduced work-related musculoskeletal disorder risk and operational efficiency. Specifically, information about how projects were identified and who participated as team members demonstrates the importance of a participatory approach to achieve positive results. Conclusion: The case study results, based upon a practitioner perspective, suggest that operational efficiency and workrelated musculoskeletal disorder reduction are often both improved by ergonomic interventions in the workplace, which is consistent with similar findings in earlier research. However, requiring more specific and standardized cost and benefit information in an award submission process is likely to provide more complete information about project results in a manner of value to practitioners, academia, and business. A future challenge is to gain more specific informa...

Surgeons reported more discomfort in when performing vaginal surgery while standing. The postural load was worse for trunk but favorable for bilateral shoulders when seated. Such differences may impact a surgeon's decision to perform vaginal surgery seated rather than standing.