ABSTRACT
Background:
Lower back pain (LBP) is the most common form of musculoskeletal disorder and a crucial occupational issue among healthcare professionals that peaks among surgeons. This cross-sectional study aimed to assess the prevalence and the characteristics and identify associated risk factors among surgeons in the Makkah region, Saudi Arabia.
Methods:
This study used a cross-sectional method among surgeons in the Makkah region of Saudi Arabia. Data were randomly collected using a self-administered questionnaire divided into demographic, individual, and occupational characteristics and prevalence data from different hospitals and cities. The subjects of the study were 208 surgeons working in different specialties.
Results:
Thirty-eight percent of surgeons were found to have back pain. The highest prevalence was found among general surgeons, followed by gynecologists. Surgeons with a longer mean duration of work experience had a significantly higher percentage of back pain sufferers. The presence of back pain, on the other hand, did not appear to be related to the surgeon’s gender, dominant hand, specialty, or other work conditions. LBP was widespread in surgeons with higher work experience, a stable job position, older age, a higher body mass index (BMI), chronic conditions, who did not exercise, and who were not athletes.
Conclusions:
General surgeons have the highest prevalence, according to the results of this study. Appropriate measures should be adopted to avoid this occupational health issue. We emphasize the importance of performing a periodic examination and follow-up on the health status of surgeons’ spines and providing educational information about LBP and the best ways to avoid it. We advocate an ergonomic examination of workplace conditions and regular counseling sessions to encourage people to use their backs more properly with correct posture.
Keywords: Lower back pain, Makkah region, prevalence, Saudi Arabia, surgeons
Introduction
Low back pain (LBP) is an important and common health problem. Healthcare providers suffer from LBP at a higher rate than many other professions. Over half of the general population is expected to seek medical help for back pain at some point in life.[1]
Worldwide, the prevalence of LBP in the general population ranges between 15 and 45 percent, with Saudi Arabia reporting a rate of 18.8%.[2] Occupational LBP is a common health problem worldwide. Due to various factors, healthcare workers (HCWs) are more likely to develop LBP.[3] This issue has significant consequences in terms of disability and frequent unavailability. Generally, female gender, advanced age, and high body mass index (BMI) are some examples of risk factors commonly associated with LBP.[4]
The problem of LBP in Saudi Arabia is similar to that in other areas worldwide. A few reports have addressed the prevalence of LBP among HCWs in Saudi Arabia.[5] Back pain may result in significant economic losses. Healthcare expenditure on LBP in terms of care and treatment costs is significant. Prior evidence has shown that recurrent back pain is strongly associated with increased odds of leaving paid employment for health-related reasons. LBP can cause various physical, psychological, and social issues.
Due to the nature of their job, surgeons are considered among the groups at high risk for LBP.[6] However, the evaluations were insufficient regarding pain descriptions and causative factors. The current study aimed to measure the prevalence of LBP among surgeons at different healthcare levels in the Makkah region of Saudi Arabia and explore related risk factors.
Methods
This study used a cross-sectional method among surgeons in the Makkah region of Saudi Arabia, including the three major cities of Jeddah, Mecca, and Taif. Surgeons from various specialties were targeted as participants, such as general surgery, orthopedics, urology, obstetrics and gynecology, otorhinolaryngology head-and-neck, neurosurgery, and others.
Data were collected during January and February 2022 from different hospitals and cities. The study subjects were 208 surgeons working in different specialties and positions such as consultant, registrar, resident, and general physician.
A pre-designed, self-administered questionnaire was used during the data collection period, and surgeons were asked to fill out the questionnaire. The participants received the questionnaire through e-mail and mobile messages. It consisted of items to collect data about participants, including personal characteristics, socio-demographic data, the position of the clinicians (consultant, registrar, resident, general physician), job history, smoking status, sports, or extra-professional activities. The questionnaire also included information about LBP (presence or absence of LBP, intensity, duration of LBP, triggering and relieving factors), work-related factors that predispose them to LBP, factors in their daily life that predispose them to LBP, knowledge about triggering factors, and prevention of their LBP.
Ethical approval for the study was obtained with Reference Ethical Number: REC 492 from the research ethics committee of King Fahad Armed Forces Hospital–Jeddah.
SPSS (statistical package for the social sciences) version 26 by IBM manufacturer was used to perform statistical analysis on the data. Qualitative data were expressed as numbers and percentages, and the Chi-squared test (χ2) was applied to test the relationship between variables. The mean and standard deviation (Mean ± SD) were used to convey quantitative data, where the Mann–Whitney test was used for non-parametric variables. A P value of less than 0.05 was considered statistically significant.
Results
Table 1 shows that the mean age and BMI of the participants were 35.86 ± 9.45 years and 24.78 ± 3.4 kg/m2, respectively. Most of the participants (69.7%) were males, 89.4% had Saudi nationality, and Egyptians were the most common non-Saudi nationality. Of them, 93.8% had the right hand as their dominant hand, and 47.6% were residents. As for the participants’ specialty, 25% were general surgeons.
Table 1.
Distribution of the studied surgeons according to their characters (No.: 208)
| Variable | No. (%) |
|---|---|
| Age | 35.86±9.45 |
| BMI | 24.78±3.4 |
| Gender | |
| Female | 63 (30.3) |
| Male | 145 (69.7) |
| Nationality | |
| Saudi | 186 (89.4) |
| Non-Saudi | 22 (10.6) |
| What nationality: | |
| Egyptian | 16 (7.7) |
| Irish | 2 (1) |
| Saudi | 186 (89.4) |
| Sudanese | 1 (0.5) |
| Syrian | 2 (1) |
| Turk | 1 (0.5) |
| Hand | |
| Left-handed | 13 (6.3) |
| Right-handed | 195 (93.8) |
| Physician position | |
| Consultant | 83 (39.9) |
| General practitioner | 3 (1.4) |
| Registrar | 23 (11.1) |
| Resident | 99 (47.6) |
| Specialty | |
| Cardiothoracic Surgery | 4 (1.9) |
| General Surgery | 52 (25) |
| Gynecology and Obstetrics | 32 (15.4) |
| Neurosurgery | 9 (4.3) |
| Ophthalmic Surgery | 16 (7.7) |
| Oral and Maxillofacial Surgery | 7 (3.4) |
| Orthopedic Surgery | 31 (14.9) |
| Otolaryngology (ENT) | 24 (11.5) |
| Pediatric Surgery | 14 (6.7) |
| Plastic Surgery | 9 (4.3) |
| Urology | 7 (3.4) |
| Vascular Surgery | 3 (1.4) |
Table 2 shows that 74.5% worked two days weekly in the operating room and 64.4% worked for 3–4 h in the operating room, with a mean year of work of 9.56 ± 8.33 years. Most surgeons (76%) had long-term jobs, 22.1% smoked, 52.4% exercised, and 13.9% were athletes.
Table 2.
Distribution of the studied surgeons according to their work conditions (No.: 208)
| Variable | No. (%) |
|---|---|
| Number Of ORs per week | |
| More than three days per week | 2 (1) |
| One day weekly | 45 (21.6) |
| Three days weekly | 6 (2.9) |
| Two days weekly | 155 (74.5) |
| Average of Operating Duration | |
| 1-2 h | 44 (21.2) |
| 3-4 h | 134 (64.4) |
| 30-60 min | 7 (3.4) |
| 5-6 h | 9 (4.3) |
| 7-8 h | 12 (5.8) |
| More than 8 h | 2 (1) |
| Years of Work | 9.56±8.33 |
| Work status | |
| Long Standing | 158 (76) |
| Sitting | 14 (6.7) |
| Both | 36 (17.3) |
| Smoking | |
| No | 162 (77.9) |
| Yes | 46 (22.1) |
| Exercise | |
| Does not exercise | 99 (47.6) |
| Exercise | 109 (52.4) |
| Are you an Athlete? | |
| No | 179 (86.1) |
| Yes | 29 (13.9) |
| Suffering, lumbar from back pain | 38 |
| No suffering from back pain | 62 |
Figure 1 shows that 79 surgeons (38%) were suffering from back pain. Table 3 shows that of the surgeons suffering from back pain, 58.2% had had this pain for more than three months. 60.7% needed a drug to relieve the pain. Of those, 52% used non-steroidal anti-inflammatory drugs (NSAIDs). Most back pain sufferers (29.1%) had pain in the lumbar and sacral regions. Of those, 43.1% needed to take a break for that pain. Of those, 50% took a break for a few minutes. Only 6.4% stopped their operation because of the pain. Of those, 40% stopped it three times. Most back pain sufferers (40.6%) reported seeking medical advice for pain, and most of them (92.4%) were resting to relieve pain. Of those, only 30.4% were doing exercises to relieve pain, and of those, the most common exercises were stretching (75.4%).
Figure 1.
Percentage distribution of the studied surgeons according to suffering back pain (No.: 208)
Table 3.
Distribution of the studied surgeons who suffer back pain according to pain pattern and clinical data (No.: 79)
| Variable | No. (%) |
|---|---|
| For How long you Have had Back Pain? | |
| One month | 11 (14.2) |
| One week | 7 (8.8) |
| Two months | 9 (11.3) |
| Two weeks | 2 (2.5) |
| Three Months | 4 (5) |
| More than Three months | 46 (58.2) |
| Did you need a drug to relieve the pain? | |
| No | 31 (39.3) |
| Yes | 48 (60.7) |
| If yes, what type of drug did you use? | |
| Analgesics, muscle relaxant | 1 (2) |
| Anti-inflammatory | 1 (2) |
| Ibuprofen | 4 (8) |
| NSAIDS | 25 (52) |
| Panadol | 1 (2) |
| Paracetamol | 8 (18) |
| Paracetamol and ibuprofen | 3 (6) |
| Paracetamol or NSAID | 3 (6) |
| Paracetamol/Codeine | 1 (2) |
| Patch | 1 (2) |
| Pain area | |
| Cervical | 4 (5) |
| Cervical, Lumper | 7 (8.8) |
| Cervical, Lumper, Sacral | 2 (2.5) |
| Cervical, Thoracic, Sacral | 1 (1.2) |
| Lumper | 22 (27.8) |
| Lumper, Sacral | 23 (29.1) |
| Sacral | 19 (24.4) |
| Thoracic, lumbar | 1 (1.2) |
| Did you need to take a break time for that pain? | |
| No | 45 (56.9) |
| Yes | 34 (43.1) |
| If yes, how long? | |
| Days | 9 (26.4) |
| Hours | 4 (11.7) |
| Minutes | 17 (50) |
| Weeks | 4 (11.9) |
| Have you ever stopped an operation because of the pain? | |
| No | 74 (93.6) |
| Yes | 5 (6.4) |
| If yes, how many times? | |
| Twice | 1 (20) |
| Three times | 2 (40) |
| Four times | 1 (20) |
| Five times | 1 (20) |
| Did you seek medical advice for your pain? | |
| No | 47 (59.4) |
| Yes | 32 (40.6) |
| What you do you do to relieve the pain (you can choose more than one) | |
| Rest | 73 (92.4) |
| Take Pain Killers | 50 (63.2) |
| Laying supine | 31 (39.2) |
| Exercise | 19 (24.4) |
| Muscle relaxant | 3 (3.7) |
| Do you do exercises to relieve pain? | |
| No | 55 (69.6) |
| Yes | 24 (30.4) |
| If yes, which type of exercises do you do? | |
| Back exercise | 1 (4.1) |
| Bridging plus stretching exercises | 1 (4.1) |
| Swimming | 1 (4.1) |
| Physiotherapy | 1 (4.1) |
| Stretching | 16 (75.4) |
| Stretching, walking, back strengthening exercises | 1 (4.1) |
| Trunk exercise | 1 (4.1) |
Table 4 illustrates that 50.6% of back pain sufferers reported that standing was making the pain worse, 19% visited a neurosurgical clinic due to back pain, and 15.2% visited an orthopedic clinic. Of the participants, 38% had chronic diseases, and the most common disease was hypertension (HTN) (23.7%). Only 5.1% of them had a history of back trauma, 2.6% had a history of back surgery, and 38.2% had pain in their limbs and other neurological symptoms in their limbs. Almost one-third of back pain sufferers (26.6%) reported that pain affected their walking, and most of them (25.3%) had a pain severity grade of four (with a mean pain severity score of 4.69 ± 2.05).
Table 4.
Distribution of the studied surgeons who suffer back pain according to pain management, chronic diseases, history of back trauma or surgery, limbs neurological symptoms, and pain severity (No.: 79)
| Variable | No. (%) |
|---|---|
| What makes the pain worse? (You can choose more than one) (No.: 79) | |
| Bending my head for a long time | 1 (1.2) |
| Laying supine | 2 (2.5) |
| Looking down for a long time | 1 (1.2) |
| Nothing | 1 (1.2) |
| On desk paperwork | 1 (1.2) |
| Sitting | 21 (26.5) |
| Standing | 40 (50.6) |
| Standing, elevating heavy things from above | 1 (1.2) |
| Standing, neck position during surgery | 1 (1.2) |
| Standing, Sitting | 10 (13.2) |
| Did you visit a Neurosurgical Clinic due to Back pain? (No.: 79) | |
| No | 64 (81) |
| Yes | 15 (19) |
| Did you visit an orthopedic clinic due to back pain? (No.: 79) | |
| No | 67 (84.8) |
| Yes | 12 (15.2) |
| Do have any Chronic Disease? | |
| No | 49 (62) |
| Yes | 30 (38) |
| If yes, what diseases? (No.: 30) | |
| Asthma | 1 (3.3) |
| DM | 2 (6.6) |
| DM, Hypertension | 5 (16.6) |
| DM, Hypertension, Dyslipidemia | 2 (6.6) |
| DM, Hypertension, Ischemic Heart Disease | 1 (3.3) |
| Dyslipidemia | 6 (20) |
| Hypertension | 7 (23.7) |
| Hypertension, Asthma | 1 (3.3) |
| Hypertension, Dyslipidemia | 4 (13.3) |
| Kidney problems | 1 (3.3) |
| History of back trauma | |
| No | 75 (94.9) |
| Yes | 4 (5.1) |
| If yes, since when? (No.:4) | |
| A month | 1 (25) |
| 5 years | 1 (25) |
| 6 years | 1 (25) |
| 7 years | 1 (25) |
| History of Back surgery | |
| No | 77 (97.4) |
| Yes | 2 (2.6) |
| If yes, when it was? (No.:2) | |
| Three years | 1 (50) |
| 30 years | 1 (50) |
| Other neurological symptoms on your limbs (you can choose more than one) (No.: 29) | |
| changes in bowel habit | 1 (3.4) |
| Numbness | 7 (24.1) |
| Numbness, Weakness | 1 (3.4) |
| Numbness, Weakness, changes in bowel habit | 1 (3.4) |
| Pain | 11 (38.2) |
| Pain, Numbness | 8 (27.5) |
| Does the pain affect your walking? | |
| No | 58 (73.4) |
| Yes | 21 (26.6) |
| How much does the pain affect your quality of life? (0 means not affecting at all and 10 is the maximum) | |
| 0 | 1 (1.2) |
| 1 | 3 (3.7) |
| 2 | 5 (6.3) |
| 3 | 14 (17.7) |
| 4 | 20 (25.3) |
| 5 | 8 (10.1) |
| 6 | 12 (15.1) |
| 7 | 7 (8.8) |
| 8 | 6 (8.1) |
| 9 | 3 (3.7) |
| (mean±SD) | 4.69±2.05 |
Table 5 demonstrates that surgeons with older age, with a higher BMI, with a non-Saudi nationality, who are general practitioners, and who have chronic diseases had a significantly higher percentage of those who had back pain (p = <0.05). A non-significant relationship was found between the presence of back pain and the surgeons’ gender, dominant hand, or specialty (p = >0.05).
Table 5.
Relationship between back pain and participants’ characters (No.: 208)
| Variable | No back pain No. (%) | Back pain No. (%) | χ 2 | P |
|---|---|---|---|---|
| Age | 32.21±7.08 | 41.9±9.81 | 6.72* | < 0.001 |
| BMI | 23.67±2.78 | 26.59±3.55 | 6.18* | < 0.001 |
| Gender | 0.08 | 0.773 | ||
| Female | 40 (63.5) | 23 (36.5) | ||
| Male | 89 (61.4) | 56 (38.6) | ||
| Nationality | ||||
| Non-Saudi | 7 (31.8) | 15 (68.2) | 9.52 | 0.002 |
| Saudi | 122 (65.6) | 64 (34.4) | 10.95 | 0.052 |
| What nationality: | ||||
| Egyptian | 5 (31.3) | 11 (68.8) | ||
| Irish | 1 (50) | 1 (50) | ||
| Saudi | 122 (65.6) | 64 (34.4) | ||
| Sudanese | 0 (0.0) | 1 (100) | ||
| Syrian | 1 (50) | 1 (50) | ||
| Turk | 0 (0.0) | 1 (100) | ||
| Hand | 0.3 | 0.58 | ||
| Left-Handed | 9 (69.2) | 4 (30.8) | ||
| Right-Handed | 120 (61.5) | 75 (38.5) | ||
| Physician position | 46.06 | < 0.001 | ||
| Consultant | 35 (42.2) | 48 (57.8) | ||
| General practitioner | 1 (33.3) | 2 (66.7) | ||
| Registrar | 8 (34.8) | 15 (65.2) | ||
| Resident | 85 (85.9) | 14 (14.1) | ||
| Specialty | 9.02 | 0.62 | ||
| Cardiothoracic Surgery | 1 (25) | 3 (75) | ||
| General Surgery | 30 (57.7) | 22 (42.3) | ||
| Gynecology and Obstetrics | 19 (59.4) | 13 (40.6) | ||
| Neurosurgery | 6 (66.7) | 3 (33.3) | ||
| Ophthalmic Surgery | 11 (68.8) | 5 (31.3) | ||
| Oral and Maxillofacial Surgery | 3 (42.9) | 4 (57.1) | ||
| Orthopedic Surgery | 18 (58.1) | 13 (41.9) | ||
| Otolaryngology (ENT) | 18 (75) | 6 (25) | ||
| Pediatric Surgery | 10 (71.4) | 4 (28.6) | ||
| Plastic Surgery | 7 (77.8) | 2 (22.2) | ||
| Urology | 5 (71.4) | 2 (28.6) | ||
| Vascular Surgery | 1 (33.3) | 2 (66.7) | ||
| Do have any Chronic Disease? | 57.24 | < 0.001 | ||
| No | 129 (72.5) | 49 (27.5) | ||
| Yes | 0 (0.0) | 30 (100) |
N.B.: *=Mann–Whitney test
Table 6 shows that surgeons with a longer mean duration of work experience had a significantly higher percentage of those who had back pain (p = <0.05). On the other hand, a non-significant relationship was found between the presence of back pain and other work conditions (p = >0.05).
Table 6.
Relationship between back pain and participants’ work conditions (No.: 208)
| Variable | No back pain No. (%) | Back pain No. (%) | χ 2 | P |
|---|---|---|---|---|
| How frequently do you work in the operating room? | 5.97 | 0.113 | ||
| More than three days per week | 1 (50) | 1 (50) | ||
| One day weekly | 21 (46.7) | 24 (53.3) | ||
| Three days weekly | 4 (66.7) | 2 (33.3) | ||
| Two days weekly | 103 (66.5) | 52 (33.5) | ||
| Average of Operating duration | 6.15 | 0.291 | ||
| 1-2 h | 29 (65.9) | 15 (34.1) | ||
| 3-4 h | 86 (64.2) | 48 (35.8) | ||
| 30-60 min | 4 (57.1) | 3 (42.9) | ||
| 5-6 h | 5 (55.6) | 4 (44.4) | ||
| 7-8 h | 5 (41.7) | 7 (58.3) | ||
| More than 8 h | 0 (0.0) | 2 (100) | ||
| Years of Work | 6.48±6.47 | 14.59±8.6 | 6.77 | <0.001 |
| Work status | 1.31 | 0.52 | ||
| Long Standing | 101 (63.9) | 57 (36.1) | ||
| Sitting | 7 (50) | 7 (50) | ||
| Both | 21 (58.3) | 15 (41.7) | ||
| Smoking | 0.25 | 0.631 | ||
| No | 99 (61.1) | 63 (38.9) | ||
| Yes | 30 (65.2) | 16 (34.8) |
Figures 2 and 3 show that surgeons who did not exercise [Figure 2] or were not athletes [Figure 3] had a significantly higher percentage of those who had back pain (p 0.05).
Figure 2.
Relationship between back pain and practicing exercises (No.: 208). N.B.: (χ2 = 16.96, P value = <0.001)
Figure 3.
Relationship between back pain and being an athlete (No.: 208). N.B.: (χ2 = 6.15, P value = 0.13)
Table 7 shows that multivariate logistic regression analysis was performed to assess the independent predictors (risk factors) of back pain among studied surgeons. It was found that having an older mean age, and a higher mean BMI were independent predictors (risk factors) of back pain among studied surgeons (Odds Ratio (CI: 95%): 1.11 (1.02-1.2), P value = 0.011, and 1.17 (1.03-1.33), P value = 0.014), respectively.
Table 7.
Multivariate logistic regression analysis of independent predictors (risk factors) of back pain among studied surgeons
| Variable | B | Wald | P | Odds Ratio (CI: 95%) |
|---|---|---|---|---|
| Age | 0.1 | 6.41 | 0.011 | 1.11 (1.02-1.2) |
| BMI | 0.15 | 5.98 | 0.014 | 1.17 (1.03-1.33) |
| Nationality | 0.58 | 0.59 | 0.442 | 0.55 (0.12-2.47) |
| Physician position | 0.001 | 4.5 | 0.212 | 0.01 (0.3-0.8) |
| Practicing exercises | 0.3 | 0.59 | 0.421 | 1.35 (0.62-2.96) |
| Being an athlete | 0.82 | 1.49 | 0.222 | 2.29 (0.6-8.65) |
Discussion
In many countries worldwide, the prevalence of LBP has been assessed, which later helps determine the causes, risk factors, and preventative measures. In most of the studies, the prevalence was significant.
This study aimed to determine how prevalent LBP is among surgeons in Makkah and its impacts. In this study, 38 percent of surgeons were found to have back pain, which is lower than findings from other studies, such as one in Iran, where up to 84.8 percent of surgeons were found to have LBP.[7] The highest prevalence was found among general surgeons, followed by gynecologists.
Additionally, vascular and cardiothoracic surgeons had the lowest rate of LBP. Men suffered from LBP at a higher rate than females, with 69.7% of males suffering from LBP, whereas males with LBP accounted for 68.2 percent of the total in previous studies.[8]
The presence of back pain, on the other hand, did not appear to be related to the surgeon’s gender, dominant hand, specialty, or other work conditions. LBP was prevalent in surgeons with higher work experience, a stable job position, older age, a higher BMI, chronic conditions, who did not exercise, and who were not athletes. Furthermore, it was in line with other studies.[9]
According to study participants, rest, painkillers, and stretching exercises were the most effective back pain relievers. The results of similar studies have come to the same conclusion.[10]
This study revealed that a lack of regular physical exercise among surgeons is one of the risk factors for LBP. Regular exercise may help maintain healthy lumbar arch alignment by improving the basal strength of the muscles around the lumbar region, thus enhancing the lumbar arch’s tolerance to stresses imposed through the trunk. One of the positives of minimizing the excess stress generated by poor posture is the improvement of movement patterns through sports activities. Another advantage of regular physical exercises is that it improves the muscular endurance of the muscles around the lumbar area in the face of continuous and recurrent spinal activity. Regular exercise will also help improve and prevent back pain by increasing flexibility and improving the weight tolerance of the intervertebral discs.[11]
One of our study’s limitations is that it only included surgeons from a hospital setting. Working conditions in various healthcare organizations, such as non-surgical specialties, are likely to differ, contributing to changes in the risk factors for LBP. To obtain more accurate and complete data, a larger sample size, including staffers and other regions, is required. The findings should help hospital administrators and healthcare authorities introduce practices and strategies to lower the incidence of LBP among surgeons in hospitals.
Conclusion
According to the findings of this study, general surgeons have the highest prevalence. Appropriate measures should be adopted to avoid this occupational health issue. We emphasize the importance of performing a periodic examination and follow-up on the health status of surgeons’ spines and providing educational information about LBP and the best ways to avoid it. We advocate an ergonomic examination of workplace conditions and regular counseling sessions to encourage people to use their backs more properly with correct posture. The prevalence of back pain was affected by age, BMI, physical activity, and chronic illnesses. Staff should be well educated and trained on proper patient handling skills, safe ergonomics and body mechanics, and the health advantages of exercise. Such modifications might help in reducing the prevalence of LBP among surgeons. As a result, the quality of patient care might improve by keeping surgeons active and productive throughout their careers.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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