Tatarian Talar, Anderson Brigitte, Pucci Michael J, Devin Courtney L, Liveright Elizabeth, Cullen Danielle, Tholey Renee, Palazzo Francesco, Altieri Maria S
Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland.
Ann Surg. 2024 Jun 28. doi: 10.1097/SLA.0000000000006426.
To investigate the association between workload and pregnancy outcomes among US surgical faculty and trainees.
Despite the increased risk of pregnancy associated complications among surgeons, most US institutions do not have formalized support to help sustain a healthy pregnancy in surgeons.
An anonymous self-administered Qualtrics survey was distributed electronically to US surgeons across all surgical specialties. Female surgical trainees/faculty with current or previous pregnancy were invited to participate. Data pertaining to demographics, workload, and pregnancy outcomes were collected for each individual pregnancy resulting in live birth. Multivariate analysis was used to assess for workload and outcomes, controlling for age, race, gravidity, and use of assisted reproductive technology. A significance level of 0.0056 was used for each outcome (Bonferroni multiple-testing adjustment 0.05/9).
817 surgeons experiencing 1348 pregnancies resulting in live birth were included. The mean (SD) age at first live birth was 32(4). The most prevalent major and neonatal complications included preeclampsia/gestational hypertension (n=196, 14.5%) and preterm delivery (n=179, 12.8%), respectively. Most institutions did not have a policy regarding workload modification (n=1189, 88.5%). Most surgeons did not modify their workload (n=862, 63.9%). When looking at individual workload metrics, feeling overworked during the last week of pregnancy correlated with risk of major complication (P=0.0001), preeclampsia/gestational hypertension (P=0.0003), and intra/post-partum complication (P=0.0001). Association with unplanned cesarean section (P=0.0096) and preterm delivery (P=0.0036) reached nominal significance.
Most surgeons do not modify their workload during pregnancy, potentially contributing to feeling overworked and peri-partum complications. There is an urgent need for a cultural shift and institutional policies to safeguard the health and wellbeing of pregnant surgeons.
探讨美国外科教员和受训人员的工作量与妊娠结局之间的关联。
尽管外科医生妊娠相关并发症的风险增加，但大多数美国机构并未提供正规支持以帮助外科医生维持健康妊娠。
通过电子方式向美国所有外科专业的外科医生发放一份匿名的Qualtrics自填式调查问卷。邀请有当前或既往妊娠经历的女性外科受训人员/教员参与。针对每例活产的单胎妊娠，收集有关人口统计学、工作量和妊娠结局的数据。采用多变量分析评估工作量与结局，并对年龄、种族、孕次和辅助生殖技术的使用情况进行控制。每项结局采用0.0056的显著性水平（Bonferroni多重检验校正，0.05/9）。
纳入了817名经历1348次活产妊娠的外科医生。首次活产时的平均（标准差）年龄为32（4）岁。最常见的主要和新生儿并发症分别为子痫前期/妊娠期高血压（n = 196，14.5%）和早产（n = 179，12.8%）。大多数机构没有关于调整工作量的政策（n = 1189，88.5%）。大多数外科医生没有调整工作量（n = 862，63.9%）。在查看个体工作量指标时，妊娠最后一周感觉工作过度与主要并发症风险（P = 0.0001）、子痫前期/妊娠期高血压（P = 0.0003）以及产时/产后并发症风险（P = 0.0001）相关。与计划外剖宫产（P = 0.0096）和早产（P = 0.0036）的关联达到名义显著性。
大多数外科医生在孕期不调整工作量，这可能导致工作过度的感觉和围产期并发症。迫切需要文化转变和机构政策来保障怀孕外科医生的健康和福祉。
