An AO Spine study published in Neurospine on June 30, 2020(*) used data collected during the COVID-19 pandemic to explore how the personal health of spine surgeons can impact perceptions, decision-making, and healthcare delivery. The study was a collaboration among 16 researchers from 10 different institutions in 6 countries on 5 continents. (**)

Spine surgeons massively impacted

While spine surgeons are not typically on the front lines of this pandemic—although some have ended up there out of choice or necessity—they have been massively impacted by it.

While spine surgeons are not typically on the front lines of this pandemic, they have been massively impacted by it.

Lead author Arash Sayari says the study is the first to specifically highlight the comorbidities of physicians. “Some may view this as controversial because it 'exposes' physicians. But truthfully, we need such transparency in the current climate to demonstrate the unity required to address a virus like COVID-19.”

Survey respondents self-reported if they had cancer, cardiac disease, diabetes, obesity, hypertension, respiratory illness, renal disease, or current tobacco use. Despite most respondents being 44 years-of-age or younger, over a third reported having at least one medical comorbidity, with hypertension and obesity being the most common. Over 10% of the respondents reported two comorbidities, and 2.6% three or more comorbidities. Over 60% reported no comorbidities and were used as the healthy control group.

There is a need for a heightened sense of awareness about this issue and the provision of proactive wellness plans in this community.

AO Spine International Research Commission Chair and corresponding author, Dino Samartzis, notes that the survey showed that spine surgeons are not necessarily the epitome of fantastic personal health and sustain a tremendous amount of stress and some have multiple comorbidities. "Studies have shown that the more comorbidities one has, the higher the chance for COVID-19-related complications if one were to ever get infected. With that in mind, spine surgeons are a high-risk group for such complications. There is a need for a heightened sense of awareness about this issue and the provision of proactive wellness plans in this community.”

Patterns are revealed

The study found a significant difference between global regions in the prevalence of obesity, hypertension, tobacco use, diabetes, and the number of comorbidities among spine surgeons, which likely reflects social and structural differences that can make it more difficult to maintain healthy habits. Sayari finds it a bit alarming that physicians who use tobacco were more likely to continue performing elective surgery during the pandemic. They were also less likely to use telecommunication. These choices increase the risk of contracting COVID-19 for both surgeon and patients.

Spine surgeons with hypertension were less likely to warn their patients if they became infected with COVID-19, which could have a substantial negative impact on patients and their families. In contrast, spine surgeons with respiratory illnesses were more likely to warn their patients, suggesting an increased appreciation for the risks of COVID-19. Surgeons with hypertension, tobacco use, or cardiac disease were less likely to be absent during patient intubation/extubation, which may increase the risk of infection for the surgeon. In contrast, there was no significant difference in the use of additional personal protective equipment during surgery.

Clinicians with multiple comorbidities were more likely to cite personal health as a current stressor and perceive their hospital management unfavorably. Since surgeons with some comorbidities were more likely to engage in riskier professional behaviors, such as performing elective surgeries during a pandemic, this suggests a pattern of not prioritizing their own health. When combined with an unfavorable perception of hospital management, this raises the possibility that they may not feel empowered to prioritize their own health.

Surgeons with some comorbidities were more likely to engage in riskier professional behaviors.

Much of the literature on physician health surrounds burnout. "However, nothing really explains the corroboration between physical and mental health," Sayari says. "We now know there’s a big link between the two, and this study further suggests that physicians need to take care of themselves both physically and mentally in order to provide the best possible care for our patients.”

Robust guidelines called for

Indeed, 95% of responding spine surgeons felt there was a need for further guidelines on performing spine surgery during crises like a pandemic. “Some institutes have some form of guidelines here and there, but standardized formal ones don’t exist in the community and are needed,” Samartzis notes.

During a time of uncertainty and panic, it is refreshing to lead a study alongside similar-minded scientists pushing for such awareness.

"We are studying the current state of affairs in the most recent phase of recovery as spine surgeons begin to return to somewhat normal work.” Samartzis hopes that this information will aid in the development of more robust guidelines.  

"This study was a great way to incorporate the fundamentals of AO Spine, utilizing the collaborative efforts of a diverse team to spread awareness to improve healthcare delivery," Sayari concludes. “During a time of uncertainty and panic, it’s refreshing to lead a study alongside similar-minded scientists pushing for such awareness.”