Ergonomic Challenges and Career Impact Among Female Neurosurgeons: A National Survey Study

Introduction: Surgery is known for its ergonomic challenges, with neurosurgeons arguably at higher risk for the sequelae of ergonomic strain given the length of neurosurgical operations, frequent use of surgical loupes, and heavy lead gear. Specifically, female neurosurgeons frequently experience ergonomic challenges and work-related musculoskeletal pain, potentially impacting career longevity and quality of care. While the current literature suggests that female surgeons accrue more ergonomic strain compared to their male counterparts, research specifically targeting the experience of female neurosurgeons is scarce. This study assesses ergonomic difficulties, pain prevalence, and perceptions among neurosurgery residents and faculty.

Methods: An anonymous web-based survey was sent to 118 U.S. neurosurgery residency programs regarding demographics, equipment and instrument difficulties, pain experiences, and career impact. Statistical comparisons were made between respondents’ ergonomic challenges.

Results: Seventy-one neurosurgeons (36 male, 35 female) participated, including 29 attendings, 39 residents, and 3 fellows. More women reported difficulties with equipment (86%) and instruments (89%) compared to men (47%), with step stools and rod cutters/benders posing the most challenges. Anatomic attributes, especially hand size, were cited as contributing factors by 76% of women versus 24% of men. Operating-related pain affected 100% of female versus 65% of male participants, with pain regions including the neck, back, and wrists. For 36% of female respondents, pain was sufficient to limit operating, whereas male participants reported milder effects. Ergonomic concerns influenced career paths for 29% of women, notably in subspecialty choice, compared to only 8% of men. Nearly all women (97%) advocated for ergonomic improvements, particularly adjustable equipment (70%) and varied instrument sizes (48%).

Conclusion : The high prevalence of ergonomic challenges among female neurosurgeons underscores an unmet need for adjustments to support diverse physical attributes, such as hand size and height. Addressing these ergonomic issues could improve comfort, reduce career-limiting pain, and enhance retention and belonging in neurosurgery.