A Comprehensive Umbrella Review for Understanding Burnout in Orthopaedic Surgery

Background: Burnout is a work-related syndrome characterized by depersonalization, emotional exhaustion, and low personal achievement. Occupational demands can lead to burnout in orthopaedic surgeons, negatively impacting patients and surgeons alike. Several systematic reviews have summarized the literature on specific aspects of burnout in orthopaedic surgery, or on orthopaedic surgeons as a subgroup in their analyses, but a high-level overview of this field is lacking. Aims: We, therefore, aimed to conduct an umbrella review (i.e., review of reviews) summarizing evidence on burnout in orthopedic surgery, focusing on its rates, associations, prevention, and management. Methods: We searched Ovid Medline, Ovid PsycINFO, EBSCO CINAHL, and CENTRAL from database inception to 16 July 2022, using the terms “orthopedic surgery”, “burnout”, and “review”. Quality assessments were conducted using the PASS checklist. An article was considered for inclusion if it was a review, summarized evidence on burnout in orthopedic surgery, and had a full text available to allow for data extraction. We present the results of our review using narrative syntheses. Results: We included eight systematic reviews and eight narrative reviews. We found burnout to be common among orthopedic surgeons, although reviews reported variable rates, thereby precluding definitive conclusions. Residents were found to be particularly at risk of experiencing burnout, with estimates of one in two being affected. Burnout was found to be positively associated with several personal-related factors (including identifying as a female or as a racial minority, experiencing work-life imbalances, and not having spousal support), as well as work-related factors (including working long hours, having stressful work relationships, and experiencing anxiety about one’s clinical competence). Literature on interventions for preventing and managing burnout was limited, although there was some evidence supporting work-hour restrictions for residents. Conclusions: Although burnout is detrimental for orthopaedic surgeons and their patients, high-quality literature in this field is scarce. Future efforts should be dedicated to conducting large-scale, prospective studies to examine burnout rates and associations as well as interventional studies to prevent and manage burnout. We provide recommendations to guide such efforts in our complementary paper on system-level interventions for burnout in orthopedic surgery.