Ergonomics in Otolaryngologic Surgery: A State of the Art Review.

OBJECTIVE: Otolaryngology is a surgical field with a high degree of ergonomic risk. The use of head-mounted lighting, loupe magnification, endoscopes, and microscopes is inherent to the field, coupled with repetitive fine motor movements in a constrained anatomic field as well as static, ergonomically unfavorable postures. We seek to review the otolaryngologic literature on ergonomics, including prevalence, severity, and interventions in decreasing work-related musculoskeletal pain. DATA SOURCES: Data were derived from clinical peer-reviewed primary literature as well as information provided by residency programs and presented at national and international meetings. REVIEW METHODS: A comprehensive review was performed by 3 independent reviewers utilizing an electronic database literature search through PubMed, Embase, and Cochrane Library. Search terms included combinations and variations of the following concepts: ergonomics, surgery, otolaryngology, work related musculoskeletal disorders, chronic cervical pain, musculoskeletal, posture, surveys, microsurgery, endoscopic surgery. Strict objective criteria for inclusion were not used due to the inherent heterogeneity in articles and lack of rigorous empirical evidence. CONCLUSIONS: Chronic musculoskeletal pain is prevalent among otolaryngologic surgeons, with many procedures producing high ergonomic risk. Most studies evaluating interventions to decrease ergonomic risks demonstrate promising results, but standardization in methods and outcome reporting is needed. IMPLICATIONS FOR PRACTICE: Literature shows that musculoskeletal pain begins in training, and there is a paucity of information related to ergonomic risk in otolaryngology residency curriculums. Work-related musculoskeletal disorders related to poor workplace ergonomics have the potential to limit career longevity and lead to physician burnout. Interventions to mitigate this risk are effective and tend to be well received by physicians.

In-Hospital Mortality for Inpatient Percutaneous Coronary Interventions in the United States.

Cardiovascular mortality is substantially higher in rural communities compared with urban communities. Understanding if disparities in inpatient percutaneous coronary intervention (PCI) persist in the United States will help inform initiatives to improve cardiovascular health. Of the more than 7 million hospitalizations in the National Inpatient Sample (2016), we identified 80,793 unweighted hospitalizations for PCI using ICD-10 procedure codes. Using survey weights, these hospitalizations projected 371,040 US admissions for inpatient PCI. For the primary analysis, we determined the association between hospital urban-rural designation and in-hospital mortality after inpatient PCI. In the secondary analysis, we evaluated the association between teaching status and this outcome. Multivariable logistic regression models, adjusted for multiple risk factors and patient characteristics, were used. Of the 371,430 hospitalizations for inpatient PCI, there were 108.9 (±2.2) admissions per 100,000 US population from urban hospitals and 152.9 (±6.3) from rural hospitals. Of the urban hospitals, there were 77.7 (±1.9) admissions per 100,000 US population at teaching hospitals (71.7%) and 30.7 (±1.0) at urban nonteaching hospitals (28.3%). In-hospital mortality did not differ between urban and rural hospitals (1.8% urban vs 1.9% rural, adjusted odds ratio for rural compared with urban: 1.15 [95% confidence interval 0.98, 1.34], p = 0.08). In urban hospitals, however, in-hospital mortality was higher in nonteaching hospitals than in teaching hospitals (2.0% nonteaching vs 1.7% teaching, adjusted odds ratio for teaching compared with nonteaching: 1.17 [95% confidence interval 1.01, 1.36], p = 0.04). In conclusion, in-hospital mortality rates after inpatient PCI were similar between urban and rural hospitals in the United States. However, among urban hospitals, nonteaching hospitals had higher rates of in-hospital mortality after PCI. In conclusion, solutions to address disparities for inpatient PCI outcomes between teaching and nonteaching hospitals are needed.