Background: Evidence-based occupational health guidelines recommend that some form of case-management approach, involving getting ‘all players onside’, should be implemented for control of absence due to back pain; this approach has not been formally tested in the UK. Methods/Results: A quasi-experimental controlled trial was conducted at selected sites of a large pharmaceutical company in the UK. The experimental intervention, delivered by occupational health nurses working to a guidelines-based protocol, was implemented at two manufacturing sites (n=1,435). Three matched sites acted as controls, delivering management as usual (n=1,483). Absence data were collected for both experimental and control sites for the two years prior to, and the two years during, the intervention period. The intended early contact (within first week) of workers absent with musculoskeletal disorders only occurred at one experimental site; the control sites had no procedure for early contact. Absence rates improved over the four years at the intervention sites compared with the control sites: a decrease of 2.0 v an increase of 0.9 days/1000 working hours. The median return-to-work time for early intervention compared with controls was 4 days v 5 days (P=NS). Considering return-to-work time irrespective of whether the intervention was delivered early or late, the median durations were also 4 days v 5 days (P< 0.05). When looking at work retention over 12 months, the median duration of subsequent absence for early intervention was 5 days compared with 11 days for controls (P=NS). For the larger number of workers receiving a late intervention, the median duration of subsequent absence was median 4 days v 11 days for controls (P< 0.05). Conclusion: The data consistently favoured a reduction in absence at the experimental sites, but organisational obstacles (black flags) precluded statistically significant results for early intervention. Implementation of certain guidelines principles (a supportive network with ‘all players onside’) can be effective for reducing absence

Study design: A systematic review of the literature to inform the development of occupational health guidelines for the management of low back pain at work. Objectives: To evaluate the evidence from occupational health settings or concerning occupational outcomes. Summary of background: Clinical guidelines for the management of low back pain (LBP) provide only limited guidance on the occupational aspects. Thus the Faculty of Occupational Medicine requested this review in order that a multi-disciplinary working group could develop the first evidence-based UK guidelines for management of LBP at work. Methods: A systematic literature search was followed by rating of the strength of the evidence plus a narrative review, by agreement between two experienced and independently-minded reviewers. There was no attempt at blinded double review or quality scoring. The final version followed peer-review by four international experts. Results: More than 2000 titles were considered. 34 systematic reviews, 28 narrative reviews, 52 additional scientific studies, 22 less rigorous scientific studies and 17 previous guidelines were identified and included. The evidence statements (rated for strength) were presented under headings that reflect a logical sequence of occupational health situations (Background, Pre-placement assessment, Prevention, Assessment of the worker presenting with back pain, Management principles for the worker presenting with back pain, Management of the worker having difficulty returning to normal occupational duties at 4–12 weeks). Some important areas were given additional narrative evidence-linked discussion (High risk patients/physically demanding jobs, Return to work with back pain, Rehabilitation programmes). Thirty six evidence-linked statements were developed to inform the guidelines group. The strongest evidence suggests that: generally the physical demands at work have only a modest influence on the incidence of LBP or permanent spinal damage; a history of LBP is not a reason to deny employment; preventive strategies based on the injury model do not reduce LBP or work loss; individual and work-related psychosocial factors play an important role in persisting symptoms and work loss; the management approach should be ‘active’ (including early work return); the combination of clinical, rehabilitation and organisational interventions designed to assist work return is more effective than single elements. However, further research is needed to identify the optimal roles of all stakeholders (clinicians, employers and workers) in case management. Conclusions: This review consolidates the emerging focus on active management of LBP at work, and indicates that approaches addressing obstacles to recovery will provide greater benefits than attempts at primary prevention. The outcome of the review has resulted in what we believe are the first truly evidence-linked occupational health guidelines for back pain in the world (. www.facoccmed.ac.uk. )

Aims

In the UK, the agricultural, military, and construction sectors have stringent rules about the use of hearing protection due to the risk of noise-induced hearing loss. Orthopaedic staff may also be at risk due to the use of power tools. The UK Health and Safety Executive (HSE) have clear standards as to what are deemed acceptable occupational levels of noise on A-weighted and C-weighted scales. The aims of this review were to assess the current evidence on the testing of exposure to noise in orthopaedic operating theatres to see if it exceeds these regulations.

The future of work brings several challenges and opportunities for occupational health and safety on three major drivers: the rapid progress of technological innovation; demographic changes, in particular ageing of the workforce and migration; and changes in the labour market, especially owing to new ways of per-forming jobs. Innovation technologies are leading to an overall transformation of industrial processes that offer huge developmental perspectives in the world of work and opportunities for society. In the field of prevention of musculoskeletal disorders, relevant progresses have been made in the clinical setting and in the context of care, also in relation to the ageing society. In the near future, the adaptation of workstations and the implementation of sensors and enabling technologies (collaborative robots and exoskeletons) will offer, together with the innovations in the clinic and orthopaedic surgery, a significant contribution to the reduction of risks from biomechanical overload, as well as support interventions to increase work ability and reduce the impact of disability. However, the potential risk scenarios for health and safety in the workplace, along with the progress in occupational health research, lead to the need for creating an inte-grated system of skills and approaches to adopt a Prevention through Design perspective. This requires designing and conceiving processes taking into consideration occupational risk prevention and guarantee-ing the return to work in a multidisciplinary and integrated perspective

Industries such as agriculture, construction and military have stringent rules about hearing protection due to the risk of noise induced hearing loss (NIHL). Due to the use of power tools, orthopaedic staff may be at risk of the same condition. The UK Health and Safety Executive (HSE) have clear standards as to what is deemed acceptable occupational noise levels on an A-weighted and C weighted scale. This review is aimed to assess evidence on noise exposure testing within Orthopaedic theatres to see if it exceeds the HSE regulations. A targeted search of online databases PUBMED and EMBASE was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) principles. This review was registered prospectively in PROSPERO. An eligibility criterion identifying clinical studies which assessed noise exposure for Orthopaedic staff in theatres were included. Noise exposure data was extracted from these studies and a comparison was made with A weighted and C weighted acceptable exposure levels as quoted in the HSE regulations. Fourteen papers were deemed eligible, which reviewed 133 Orthopaedic operations and 64 Orthopaedic instruments. In total, 61% (81 of 132) of Orthopaedic operations and 70% (45 of 64) of instruments exceeded the noise regulations on an A weighted scale. 22% (10 of 46) of operations exceeded the maximum C weighted peak acceptable noise level. Orthopaedic instruments and operations can exceed safe occupational noise levels. NHS Trusts have clear policies about noise exposure in the workplace but have yet to identify Orthopaedic theatres as a potential at risk area. Orthopaedic staff need education, monitoring and protection whereas Employers and Occupational Health should consider assessments to identify at risk staff in Orthopaedic theatres and offer preventative methods from NIHL

Aim. The aim of the present work was (i) to survey the situation of healthcare regarding the use of antibiotics in orthopaedics and trauma surgery in Germany, (ii) to determine which empiric antibiotic regimens are preferred in the treatment of periprosthethic joint infections (PJI) and (iii) to evaluate the hypothetical antibiotic adequacy of the applied empirical antibiotic therapy regimens based on a patient collective of a German university hospital. Method. A survey on empirical and prophylactic antibiotic therapy was conducted at German university and occupational health clinics (BG clinics), each in the specialties of orthopedics and trauma surgery. A total of 71 clinics were contacted by email. The questionnaire sent included open-ended questions on systemic antibiotic prophylaxis in primary hip arthroplasty; a distinction was made between hip arthroplasty due to femoral fractures and elective hip arthroplasty. In addition, the empirical antibiotic therapy used in PJIs was surveyed. To determine the success rate of prophylaxis and therapy according to sensitivity to the antibiotics applied, the survey results were compared with previously published data on antimicrobial treatment in n=81 PJI patients treated in our department between 2017 and 2020. Results. In 93.2% (elective) and 88.6% (fracture care) of the hospitals, 1st- and 2nd-generation cephalosporins are administered perioperatively for infection prophylaxis in primary hip arthroplasty. In contrast, empiric antibiotic treatment for PJI showed a clearly inhomogeneous therapeutic picture. Monotherapy with an aminopenicillin/betalactamase inhibitor is most frequently used (38.7%); 1st- and 2nd-generation cephalosporins are second most frequently used as monotherapy (18.2%). In addition, dual combination therapies have become established, mostly aminopenicillin/betalactamase inhibitor or 1st- and 2nd-generation cephalosporins, whose administration is supplemented with another antibiotic. The most common combination in PJI is aminopenicillin/betalactamase inhibitor + vancomycin (11.4%). The most widely used therapy (monotherapy with aminopenicillin/betalactamase inhibitor) would have covered 69.0% of PJI patients. Monotherapy with 1st- and 2nd-generation cephalosporins would have been susceptible to 57.8% of PJI patients. In contrast, a combination of vancomycin + 1st- and 2nd-generation cephalosporins would have been most effective, with an efficacy of 91.5% according to the resistograms, but this was used by only two hospitals. Conclusions. Empirical antibiotic therapy for the treatment of PJI is applied in more than half of the clinics with a single broad-spectrum beta-lactamase inhibitor antibiotic. This discrepancy between the everyday care in the clinics and the administration of clearly more effective combination therapies underlines the need for recommendation guidelines

Aims. Elective operating was halted during the COVID-19 pandemic to increase the capacity to provide care to an unprecedented volume of critically unwell patients. During the pandemic, the orthopaedic department at the Aneurin Bevan University Health Board restructured the trauma service, relocating semi-urgent ambulatory trauma operating to the isolated clean elective centre (St. Woolos’ Hospital) from the main hospital receiving COVID-19 patients (Royal Gwent Hospital). This study presents our experience of providing semi-urgent trauma care in a COVID-19-free surgical unit as a safe way to treat trauma patients during the pandemic and a potential model for restarting an elective orthopaedic service. Methods. All patients undergoing surgery during the COVID-19 pandemic at the orthopaedic surgical unit (OSU) in St. Woolos’ Hospital from 23 March 2020 to 24 April 2020 were included. All patients that were operated on had a telephone follow-up two weeks after surgery to assess if they had experienced COVID-19 symptoms or had been tested for COVID-19. The nature of admission, operative details, and patient demographics were obtained from the health board’s electronic record. Staff were assessed for sickness, self-isolation, and COVID-19 status. Results. A total of 58 surgical procedures were undertaken at the OSU during the study period; 93% (n = 54) of patients completed the telephone follow-up. Open reduction and internal fixation of ankle and wrist fractures were the most common procedures. None of the patients nor members of their households had developed symptoms suggestive of COVID-19 or required testing. No staff members reported sick days or were advised by occupational health to undergo viral testing. Conclusion. This study provides optimism that orthopaedic patients planned for surgery can be protected from COVID-19 nosocomial transmission at separate COVID-19-free sites. Cite this article: Bone Joint Open 2020;1-6:302–308

Surgeons working in orthopaedic operating theatres are exposed to significant noise pollution due to the use of powered instruments. This may carry a risk of noise-induced hearing loss (NIHL). This study was designed to quantify the noise exposure experienced by orthopaedic surgeons and establish whether this breaches occupational health guidelines for workplace noise exposure. A sound dosimeter was worn by the operating surgeon during 3 total hip replacements and 2 total knee replacements. A timed record of the procedures was kept concurrently. Noise levels experienced during each part of the procedure were measured and total noise exposures calculated. Quantified noise exposures were compared with occupational health guidelines. Noise exposure in total hip replacement averaged 4.5% (1.52–6.45%) of the allowed daily dose (average duration 77.28 min). Total knee replacement exposure was 5.74% (4.09–7.39%) of allowed exposure (average duration 69.76min). Maximum sound levels approached, but did not exceed recommended limits of 110 dBA (108.3dBA in total hip replacement and 107.6dBA in total knee replacement). Transient peak sound levels exceeded occupational health maximum limits of 140dB on multiple occasions during surgery. Overall total noise dose during orthopaedic surgery was acceptable, however orthopaedic surgeons experience brief periods of noise exposure in excess of legislated guidelines. This constitutes a noise hazard and carries a significant, but unquantified risk for NIHL

Abstract. Background. Healthcare workers have had to make rapid and drastic adjustments to their practice in response to the COVID-19 pandemic. This work describes the effect on their physical, mental, financial and family well-being and assesses the support provided by their institutions. Methods. An online survey was distributed through medical organisations, social media platforms and collaborators to staff based in an operating theatre environment. Results. 1590 responses were received from 54 countries. Average age of participants was between 30 and 40 years old, 64.9% were male, 79.5% were surgeons, 6.2% nurses, 5.4% assistants, 4.2%. Of the total 32.0% had become physically ill since the start of the pandemic. Physical illness was more likely in those with reduced access to personal protective equipment (OR 4.62; CI 2.82–7.56; p<0.001) and regular breaks (OR 1.56; CI 1.18–2.06; p=0.002). Those with a decrease in salary (29% of participants) were more likely to have an increase in anxiety (OR 1.50; CI 1.19–1.89; p=0.001) and depression scores (OR 1.84; CI 1.40–2.43; p<0.001) and those who spent less time with family (35.2%) were more likely to have an increase in depression score (OR 1.74; CI 1.34–2.26; p<0.001). In terms of support, only 36.0% had easy access to occupational health services, 44.0% to mental health services, 16.5% to 24 hour rest facilities and 14.2% to 24 hour food and drink facilities. Conclusion. This work has highlighted a need and ways in which to improve conditions for the health workforce, which will inevitably have a positive impact on the care received by patients

Background: Current evidence emphasises the need for workplace managers to become more involved in the case management of the worker with low back pain (UK Guidelines , 2000). Purpose: To establish health service managers’ needs in relation to the management of the worker with low back pain (LBP). Methods: A self administered questionnaire was distributed to all departmental managers (n =63) at a major Irish teaching hospital. The questionnaire comprised of a series of quantitative and qualitative questions relating to aspects of management of the worker with LBP including facilitation of return to work and organisational support for managers. Quantitative data were summarised using descriptive statistics. Qualitative data were transcribed, coded and analysed using the qualitative data analysis approach of . Miles and Huberman (1994). . Results: A response rate of 76% (n =48) was achieved. Of these 63%(n=30) had experience of managing LBP related sick leave among staff. Common themes which emerged from the qualitative data included lack of staff resources to accommodate return to work of a worker at less than full physical work capacity, lack of specific guidance from the occupational health department regarding expected work capacity of the worker with LBP and difficulty dealing with attitudes of colleagues towards the worker with LBP. Conclusion: Strategies aimed at improving the management of the worker with LBP and facilitating earlier return to work need to give consideration to improving staff resources, provision of clear guidelines from occupational health departments and guidance for managers regarding ways of supporting both the worker with LBP and his/her colleagues

Objective: To implement an early occupational intervention which tackles the psychosocial factors (yellow and blue flags) that influence recovery from occupational back pain. Design: An early, psychosocial, occupational health nurse-led intervention using a basic ‘counselling’ technique that reinforces evidence-based messages and advice, along with availability of modified work. Subjects: 206 workers from a sample of Glaxosmithkline sites who took absence due to back pain. Outcome measures: Duration of presenting absence. Results: The target for contacting the worker was achieved at Site 1 (mean 3 days), but not Site 2 (mean 12 days). Results showed that late contact of absent workers (> 1 week) was significantly associated with both longer presenting absence and fewer recipients of the psychosocial intervention, compared with early contact. Preliminary results show that the psychosocial intervention (irrespective of early or late contact) reduces the length of presenting absence by half. Conclusions: The lack of early contact at Site 2 was due to local sickness absence management differences. This study reveals a third class of obstacles to recovery – organisational policies (black flags) – that can negate the effect of occupational rehabilitation programs

Introduction: Trauma surgery creates enormous mental stress for operating surgeons, especially in trainees. This is responsible for sympathetic hyperactivity which can be measured by various cardio vascular variables. Air Traffic control is recognised as one of the most stressful occupations with accepted risks and incorporated remedies. We compared the stress during surgery with that experienced by air traffic controllers. Materials & Methods: The study included 40 trainee doctors. We obtained multiple readings of heart rate, diastolic and systolic Blood Pressure with ambulatory monitoring methods when they operated. This was compared to their resting measurements obtained at home. Similar measurements were performed for Air Traffic controllers, while at work and at home. Results: The heart rate and blood pressure were increased at the beginning and during surgery. Student t test was applied to compare the mean values obtained intra-operatively and in resting conditions. This suggested the increase to be statistically significant. This increase in autonomic function variables was compared with the values similarly obtained for Air Traffic Controllers. Operating surgeons manifested significant increase in comparison to the other group. Discussion: Stress can not be eliminated but can be over come with experience. Recurrent sympathetic hyperactivity may contribute to various stress related ailments. As in Air Traffic controllers, stress should be accepted as integral part of occupation. Stress relieving manoeuvres should form an important part of surgeons’ occupational health and medical school/ foundation years curriculum. Conclusions: Surgeons experience more emotional and mental stress than occupations accepted to be most stressful

Purpose and background of the study The occupational health department for the London Ambulance Service (LAS) had numbers of employees reporting low back pain (LBP). The purpose of the study was to determine the lifetime, and point prevalence of LBP and to report the Fear Avoidance Beliefs of this study population within the LAS. Summary of the methods used and the results The cross-sectional study involved 2448 Accident & Emergency (A& E) operational employees (Paramedics and Qualified Ambulance Technicians). A questionnaire with covering letter was posted to a randomly selected number of A& E staff (n=1000). The questionnaire included a validated version of the Fear Avoidance Beliefs Questionnaire (FABQ) and the General Health Questionnaire (GHQ). The response rate was 50% (n= 504). 91% of the responding sample had a lifetime prevalence of LBP and also answered the modified FABQ questions. The mean of the activity fears scale was 4.18 (SD = 1.14) and the mean of the work fears was 4.91 (SD = 1.08), indicating that most respondents held very negative beliefs regarding LBP in relation to work and activities. Those who had experienced LBP reported more psychological problems on the GHQ. Statement of conclusion The prevalence of low back pain amongst responding A& E staff is high compared to National surveys. This population also demonstrated very negative fear avoidance beliefs for LBP. Responses to the GHQ indicated the sample population to be just on the positive side of mid-point. The reporting of LBP was significantly associated with psychological problems

Introduction: The nature of orthopaedic surgery often demands a high level of physical activity that may be associated with a variety of musculoskeletal symptoms. We designed this study to identify the prevalence and variety of musculoskeletal symptoms affecting orthopaedic surgeons working in Britain. Methods: A questionnaire was designed to explore relevant musculoskeletal symptoms. The case group included all fellows of the British Orthopaedic Association working in Britain (n=1300) and the control group was the primary anaesthetist working with that surgeon (n=1300). All questionnaires were anonymous and completed by post. Results: The response rate was 47% (n=605) for orthopaedic surgeons and 20% for the control group (n=255). The prevalence of back pain was higher in the orthopaedic surgeons (50%) compared to controls (40%; p< 0.05) as was neck pain (28% vs 19%; p< 0.01), carpal tunnel syndrome (20% vs. 5%; p< 0.001), hand pain (20% vs 8%; p< 0.001) and shoulder pain (29% vs 19%; p< 0.005). Although orthopaedic surgeons reported more symptoms than controls, it was notable that significantly more controls used analgesics compared to surgeons (59% vs 35%; p< 0.001). The use of glucosamine was equal in both groups (3% vs 6%). There were two reports of injuries in surgeons that occurred whilst operating (meniscal tear and lumbar disc prolapse). Significantly more surgeons felt their symptoms would lead to early retirement compared to controls (15% vs 8%; p< 0.01). Discussion: This study has shown that occupational musculoskeletal morbidity is higher in orthopaedic surgeons compared to a control group. The reasons for this are multifactoral. The cumulative nature of the symptoms may lead to early retirement in more orthopaedic surgeons compared to other specialities. This study highlights an important occupational health issue and raises the question of increased health and safety awareness from our managers when considering the demands placed on surgeons

The perils and risks associated with worklessness have only recently been recognised and given an evidence base. 1. These demonstrate that economic inactivity and the ways it can be effectively addressed must be placed high on the list of priorities to be tackled by both public and occupational health. But what of the evidence that work is good for health and wellbeing? This lacuna in knowledge and understanding has recently been closed by a detailed systematic review of the medical and scientific literature which provides compelling evidence that, with very few exceptions, work and in particular employment is good for health and wellbeing. 2. The time is ripe to achieve the tipping-point to gain a shift in cultural attitudes to health and work, and particularly so among healthcare professionals. Moreover the majority of people in receipt of state incapacity benefits report subjective health complaints which are in many ways no different to the common health problems (CHPs) which have been shown to have a high prevalence in the general population. 3. ,. 4. Unexplained symptoms in people accessing healthcare. 5. ,. 6. may well be another feature of the failure to gain a proper understanding of the nature and origins of perceived illness manifesting as CHPs, and to develop effective interventions. There is extensive clinical evidence that personal beliefs aggravate and perpetuate illness. 7. and play a central role the more subjective the health complaint. 1. Psychological and social factors need to be addressed as obstacles to recovery and (return to) work. Chronicity and incapacity are not inevitable in people with CHPs. Given the right support, opportunities and encouragement these health problems can be effectively managed. Illness, sickness and Incapacity need urgent recognition as psychosocial rather than medical problems. More and better healthcare will not provide the answer. Evidence is accumulating that interventions principally based on cognitive and behavioural practices substantially improve recovery from ill-health and significantly increase the likelihood of return to work among incapacity benefit recipients who participate in condition-management programmes as part of the Government’s Pathways to Work Pilots. Asound endorsement of these approaches has been the recent decision by government to extend the Pathways to Work initiatives across the country in the next few years

Background: The influence of psychosocial factors on absence rates is incompletely understood; much research has been cross-sectional, involving a limited range of psychosocial variables. This paper reports a large prospective study of the relationship between psychosocial factors and absence rates due to low back pain across a multi-site UK pharmaceutical company. Methods/Results: Baseline data were collected from 4,637 workers, and absence data over the ensuing 15 months were obtained from company records. In addition to demographic and historical variables, a wide range of psychosocial variables was included with a focus on occupational psychosocial factors, termed ‘blue flags’. Validated questionnaires were used to quantify job satisfaction, social support, attribution of cause, control over work, and organisation of work, with psychological distress as a ’yellow flag’. 176 workers took absence due to back pain during follow-up. Previously defined cut-off scores were used to categorise hypothesised risk; scores beyond the cut-off point were considered detrimental, and the ‘flag’ was considered to be ‘flying’. Odds ratios (OR) were calculated to explore the association between the flags and taking sick leave; a statistically significant association was found with ORs between 1.5 and 2.9. The cut-off scores were then used to compare the length of absence between workers who had zero flags flying and those who had one or more flags flying. Absence over the ensuing 15 months was significantly longer for those people who had one or more flags flying (mean 10.6 days compared with 6.1 days, P< 0.05). There was a trend for longer absence with more flags flying. Conclusion: This prospective study confirms the influence of blue, as well as yellow, psychosocial flags on both the taking of sick leave and the subsequent length of absence. This supports their hypothesised role as obstacles to recovery that might be suitable targets for occupational health interventions

The April 2023 Research Roundup³⁶⁰ looks at: Ear protection for orthopaedic surgeons?; Has arthroscopic meniscectomy use changed in response to the evidence?; Time to positivity of cultures obtained for periprosthetic joint infection; Bisphosphonates for post-COVID-19 osteonecrosis of the femoral head; Missing missed fractures: is AI the answer?; Congenital insensitivity to pain and correction of the knee; YouTube and paediatric elbow injuries.

The April 2024 Spine Roundup³⁶⁰ looks at: Lengthening behaviour of magnetically controlled growing rods in early-onset scoliosis: a multicentre study; LDL, cholesterol, and statins usage cause pseudarthrosis following lumbar interbody fusion; Decision-making in the treatment of degenerative lumbar spondylolisthesis of L4/L5; Does the interfacing angle between pedicle screws and support rods affect clinical outcomes after posterior thoracolumbar fusion?; Returning to the grind: how workload influences recovery post-lumbar spine surgery; Securing the spine: a leap forward with s2 alar-iliac screws in adult spinal deformity surgery.

The subject of noise in the operating theatre was recognized as early as 1972 and has been compared to noise levels on a busy highway. While noise-induced hearing loss in orthopaedic surgery specifically has been recognized as early as the 1990s, it remains poorly studied. As a result, there has been renewed focus in this occupational hazard. Noise level is typically measured in decibels (dB), whereas noise adjusted for human perception uses A-weighted sound levels and is expressed in dBA. Mean operating theatre noise levels range between 51 and 75 dBA, with peak levels between 80 and 119 dBA. The greatest sources of noise emanate from powered surgical instruments, which can exceed levels as high as 140 dBA. Newer technology, such as robotic-assisted systems, contribute a potential new source of noise. This article is a narrative review of the deleterious effects of prolonged noise exposure, including noise-induced hearing loss in the operating theatre team and the patient, intraoperative miscommunication, and increased cognitive load and stress, all of which impact the surgical team’s overall performance. Interventions to mitigate the effects of noise exposure include the use of quieter surgical equipment, the implementation of sound-absorbing personal protective equipment, or changes in communication protocols. Future research endeavours should use advanced research methods and embrace technological innovations to proactively mitigate the effects of operating theatre noise.

Cite this article: Bone Joint J 2024;106-B(10):1039–1043.

During the pandemic of COVID-19, some patients with COVID-19 may need emergency surgeries. As spine surgeons, it is our responsibility to ensure appropriate treatment to the patients with COVID-19 and spinal diseases. A protocol for spinal surgery and related management on patients with COVID-19 has been reviewed. Patient preparation for emergency surgeries, indications, and contraindications of emergency surgeries, operating room preparation, infection control precautions and personal protective equipments (PPE), anesthesia management, intraoperative procedures, postoperative management, medical waste disposal, and surveillance of healthcare workers were reviewed. It should be safe for surgeons with PPE of protection level 2 to perform spinal surgeries on patients with COVID-19. Standardized and careful surgical procedures should be necessary to reduce the exposure to COVID-19.