Quantifying Ergonomic Risk Among Otolaryngology Surgeons

Importance: Performing otolaryngology operations requires sustained static posture and precision in confined spaces, placing surgeons at high risk of musculoskeletal strain. Ergonomic challenges have been implicated in acute discomfort and long-term disability, yet prospective intraoperative assessments remain limited. Objective: To quantify intraoperative ergonomic risk and acute musculoskeletal pain among otolaryngologists during surgical procedures and to examine demographic and procedural factors associated with discomfort. Design, Setting, and Participants: This prospective cross-sectional study was conducted at a single academic institution from August 2024 to March 2025. Eligible participants included otolaryngology surgeons (residents, fellows, or attending physician faculty) actively performing head and neck operations during the study period. Main Outcomes and Measures: Primary outcomes included preoperative and postoperative numeric pain scores (0-10 scale) and intraoperative ergonomic risk, assessed using the Rapid Upper Limb Assessment (RULA). Secondary outcomes included baseline Neck Disability Index, Oswestry Low Back Disability scores, and associations of demographic and procedural variables with pain. Results: Seventeen otolaryngology surgeons (12 residents/fellows, 5 attending physicians) actively performing head and neck operations participated in the study. The mean (SD) age of surgeons was 35.6 (10.6) years; 5 participants (29%) were female, and 12 (71%) were male. Among the 17 otolaryngologists observed across 80 operations, 970 intraoperative RULA scores were collected. Overall, 143 of 386 attending physician (37%) and 249 of 584 resident scores (43%) indicated medium to high ergonomic risk (RULA 5-7). In mixed-effects modeling, greater case difficulty was associated with increased pain scores, and larger glove size was associated with higher pain scores. No significant associations were observed between pain scores and surgeon weight, sex, age, training level, or the length or type of procedure. RULA scores increased with operative duration, especially among surgeons 40 years and older. Postoperative surveys indicated that 23 of 80 procedures (28.8%) required intraoperative position changes due to discomfort, with 7 (8.8%) reporting distraction due to pain, 2 (2.5%) requiring a break, and 1 (1.3%) reporting interference with surgical performance. Conclusions and Relevance: In this cross-sectional study, otolaryngology surgeons experienced measurable increases in pain and sustained high rates of intraoperative ergonomic risk, even during routine procedures. Hand size was associated with greater intraoperative discomfort, underscoring the multifactorial nature of 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.