Prevalence, Risk Factors, and Impacts of Musculoskeletal Injuries Among Plastic Surgeons: A Systematic Review and Meta-Analysis

<b>Background:</b> Poor ergonomics may lead to musculoskeletal (MSK) injuries in surgeons, prompting practice modification, early retirement, and errors. We hypothesized that each plastic surgery subspecialty faces unique ergonomic challenges. We sought to identify the prevalence, risk factors, and impact of MSK injuries among plastic surgeons by subspecialty. <b>Methods:</b> In this systematic review and meta-analysis (CRD420251026702), MEDLINE, Embase, CINAHL, Web of Science, and Scopus were searched from inception to November 9, 2024, for studies reporting on injury prevalence among plastic surgeons. Methodological quality was assessed using the Joanna Briggs Institute Checklist for Prevalence Studies. The primary outcome was the literature-pooled MSK injury prevalence. Secondarily, we reviewed ergonomic risk factors and impacts. Pairwise and nonpairwise meta-analyses and random effects meta-analyses were conducted for dichotomous and continuous outcomes, respectively. <b>Results:</b> Fifteen studies were included, encompassing 3313 plastic surgeons. Very low-certainty evidence suggested that 72.0% reported MSK injury (95% CI [63.4, 79.3]), with the greatest prevalence in aesthetic surgeons (84.3%; 95% CI [76.0, 90.1]) and lowest among craniofacial surgeons (69.4%; 95% CI [52.8, 82.1]). Symptoms mostly occurred in the neck (47.0%), lower back (37.0%), and upper back (32.0%). Consequently, 38.6% worried about disability, 10.1% took time off, and 5.9% decreased their caseload. Practice duration, caseload, and age were risk factors. <b>Conclusion:</b> Ergonomic-related injuries varied among subspecialties, affecting the neck (craniofacial, oculoplastic, and microsurgeons), forearm/wrist/hands (hand surgeons), and lower back (aesthetic surgeons). Tailored ergonomic education programs are needed to protect the health and well-being of plastic surgeons.