Surgeon Energy Expenditure and Substrate Utilization During Simulated Spine Surgery

Area of Science:

• Orthopaedic Surgery
• Sports Medicine
• Human Physiology

Background:

• Orthopaedic surgery is physically demanding, leading to surgeon fatigue and burnout.
• Surgeon fatigue is linked to increased errors and potential patient safety risks.
• The metabolic cost of surgical procedures remains largely unquantified.

Purpose of the Study:

• To quantify the metabolic cost of simulated orthopaedic spine surgery.
• To assess energy expenditure (EE) and substrate utilization during a lumbar laminectomy and fusion.
• To explore the relationship between physical demands and surgeon performance.

Main Methods:

• Eight subjects performed simulated one-level lumbar laminectomy and fusion on cadavers.
• Indirect calorimetry measured oxygen consumption (VO2) to calculate energy expenditure (EE).
• Triaxial accelerometers were used to estimate total EE.

Main Results:

• Simulated surgery resulted in a peak VO2 of 11.3 ± 0.4 mL/kg/min.
• Total energy expenditure was 132 ± 6 kcal (142 ± 7 kcal/hr).
• Subjects utilized a higher percentage of carbohydrates (53% ± 4%) than fat (47% ± 7%).

Conclusions:

• Simulated orthopaedic spine surgery significantly increases energy expenditure compared to rest.
• Surgeons exhibited higher carbohydrate utilization than anticipated for the activity's intensity.
• Quantifying metabolic costs may inform strategies to mitigate surgeon fatigue and enhance patient safety.