Chronic pain among surgeons needs to be addressed

Dr. Park and Dr. Cerame deserve credit for bringing to light an issue that has rarely been discussed, but is of great importance to all surgeons and particularly to vascular surgeons: occupational health hazards. In addition to the general problems pointed out by Dr. Park, vascular surgeons face special hazards.

Aside from the long hours, little sleep, and the stresses of taking care of sick patients who may not do well despite our best efforts, vascular surgeons should be aware of special risks they face. These risks are associated both with open vascular and endovascular procedures. It is crucial that even young vascular surgeons maintain an awareness of these risks so they can be prevented or at least minimized – and treated promptly if symptoms develop.

Dr. Frank J. Veith

The open operations that vascular surgeons are called upon to perform, particularly for advanced disease, are often time consuming and intense. They may require bending or working with the head or back flexed for long periods. A difficult redo leg bypass is one such example. Spinal disk problems are common in both the cervical and lumbosacral areas in vascular surgeons who perform these lengthy arterial operations.

Vascular surgeons with busy endovascular practices face even greater occupational risks.

Endovascular surgeons are exposed daily to radiation, none of which is totally safe. Increased risks of cancer and cataracts are the most prominent risks, and there are marked differences in individual susceptibility to these dangers. Accordingly every effort must be made throughout a vascular surgeon’s career to minimize this exposure, both by emphasizing radiation safety, taking every possible protective measure, and being constantly aware of the hazards.

One of the protective measures is the wearing of lead gowns. Heavier lead aprons are more protective and should be used. It is not surprising, however, that all interventionalists who use lead protective gear for long hours also face an increased risk of cervical and lumbosacral disk problems, which can require treatment or even end their careers. Devices that limit the weight of these aprons and place the operator further from the radiation source are being developed and should be explored by all those who use radiation imaging in their daily practice.

All vascular surgeons should take the study by these researchers seriously and heed its warnings.

Dr. Frank J. Veith is professor of surgery at New York University Medical Center and Case Western Reserve University, and the William J. von Liebig Chair in Vascular Surgery at the Cleveland Clinic Foundation. He is also an associate medical editor of Vascular Specialist.