Otolaryngology surgeons may frequently experience medium to high ergonomic risk and increased intraoperative pain during head and neck procedures.
In a prospective cross-sectional study, researchers evaluated intraoperative ergonomic risk using the Rapid Upper Limb Assessment (RULA) alongside pre- and postoperative pain scores. They recruited 17 otolaryngology surgeons, including residents, fellows, and attending physicians, observed across 80 operations at a single academic center from August 2024 to March 2025. The researchers collected 970 RULA measurements at 30-minute intervals. The primary outcomes were changes in pain scores and intraoperative ergonomic risk; secondary outcomes included associations between pain and demographic or procedural characteristics such as case difficulty, operative duration, age, and glove size.
Results
Across the procedures, 37% of attending physician RULA scores and 43% of resident and fellow scores were in the medium to high risk range, indicating sustained ergonomic strain. The mean RULA score per procedure was 4.34.
Pain increased during operations and was associated with case difficulty. Cases rated with the most difficulty had higher pain scores compared with average cases. Ergonomic strain worsened over time with longer procedures, particularly among surgeons aged 40 years and older, while younger surgeons didn't show this pattern.
Glove size was also associated with increases in pain, with larger glove sizes linked to higher pain scores. Pain wasn't associated with weight, age, sex, training level, procedure type, or operative duration.
Intraoperative discomfort affected the workflow in some cases. Surgeons reported changing position in about 29% of the procedures, experiencing pain-related distractionin 9%, and requiring a break in 3%; interference with surgical performance was reported in 1% of cases.
Limitations
The study was conducted at a single center with a small sample size, which may have limited generalizability. Pain was assessed immediately following procedures and may not have reflected longer-term effects. RULA scores were collected at intervals rather than capturing the single worst posture, which may have underestimated peak ergonomic strain. As an observational study, the findings didn't establish causation.
Conclusion
Otolaryngology surgeons experienced measurable increases in pain and sustained ergonomic strain during operations. “These findings highlight the urgent need for increased ergonomic awareness, targeted training, and equipment redesign to mitigate risk and preserve surgeon longevity,” wrote lead study author Jacqueline Oh, BA, of the University of Oklahoma College of Medicine, and colleagues.
The study authors reported no conflicts of interest.
