Ergonomic practices and interventions in plastic and reconstructive surgery: A systematic review

Introduction: Ergonomics have significant implications for the surgical workforce that performs at the interface between human-operated equipment and patient anatomy to achieve clinical results. This systematic review evaluated the literature discussing ergonomics in plastic surgery to explore current knowledge, evaluate trends, and identify prime gaps for future study. Methods: A systematic search strategy was developed by a licensed librarian and plastic surgeon to query all manuscripts evaluating ergonomics in plastic and reconstructive surgery. Two independent reviewers screened abstracts, evaluated full texts, and extracted data. Results: Forty-six studies were ultimately included. The number of published studies increased significantly over time when evaluated by year (ρ = 0.660, p < 0.001), with 17 (36.9%) written since 2020. Studies more commonly discussed musculoskeletal pain/disorders (n = 23) compared to surgical instrumentation or technology (n = 18, p = 0.390), operative posture (n = 14, p = 0.041), surgical technique (n = 6, p = 0.002), peri-surgical practices (n = 5, p < 0.001), and surgeon physiology (n = 3, p < 0.001). Among the 19 studies, including interventions, approaches more frequently involved novel instrumentation or technology (n = 14, 73.4%) compared to peri-surgical practices (n = 3, 6.5%, p < 0.001) or operative posture (n = 2, 4.3%, p < 0.001). Conclusions: Ergonomics in plastic surgery has gained significant interest over time, with recent years representing a large proportion of published literature. Although most studies discuss musculoskeletal pain, the proportion of studies addressing posture and surgical practices are comparatively underrepresented, suggesting an opportunity for future intervention.