For Doctors in a Hurry
- Researchers investigated how intraoperative ergonomic risk and musculoskeletal pain affect otolaryngologists during head and neck surgical procedures.
- This prospective cross-sectional study monitored 17 surgeons across 80 operations using a standardized tool to quantify upper limb strain.
- High ergonomic risk scores occurred in 43 percent of resident assessments, while 28.8 percent of procedures required intraoperative position changes.
- The authors concluded that case difficulty and larger glove size significantly correlate with increased intraoperative pain scores for surgeons.
- These findings suggest that targeted ergonomic training and equipment redesign are necessary to mitigate physical strain and preserve surgeon longevity.
The Occupational Burden of Surgical Posture
Work-related musculoskeletal disorders represent a significant occupational hazard for surgeons, frequently leading to chronic pain and potential career-ending disabilities [1]. While the highest prevalence of strain typically involves the neck, lower back, and shoulders, the specific ergonomic burden varies significantly across surgical specialties and procedural types [2]. Beyond physical injury, these ergonomic challenges are closely linked to physician burnout, which affects a substantial portion of the surgical workforce and can compromise patient safety [3]. Recent evidence suggests that individual factors, such as hand size and the use of specific surgical instrumentation, may predispose certain clinicians to higher rates of discomfort [4]. Despite the availability of objective tools to assess posture and strain, prospective data on real-time intraoperative risk remain sparse [5]. A recent study now provides a detailed quantification of these risks during head and neck procedures, offering actionable insights to preserve surgeon longevity.
Quantifying Intraoperative Strain
To evaluate the physical toll of head and neck procedures, researchers conducted a prospective cross-sectional study at a single academic institution between August 2024 and March 2025. The cohort included 17 otolaryngology surgeons, comprising 12 residents or fellows and 5 attending physicians. The participants had a mean age of 35.6 years (standard deviation of 10.6 years), with 5 female surgeons (29%) and 12 male surgeons (71%). By tracking this cohort through their daily operative schedules, the investigators sought to identify how individual characteristics and procedural demands contribute to musculoskeletal strain. The primary outcomes focused on preoperative and postoperative numeric pain scores (measured on a 0 to 10 scale) and intraoperative ergonomic risk. To quantify this risk, the authors utilized the Rapid Upper Limb Assessment (RULA). This validated observational tool assigns scores based on body posture, force, and repetition, providing a standardized method to flag positions that lead to muscle fatigue or injury. Secondary outcomes included baseline assessments of chronic strain using the Neck Disability Index and Oswestry Low Back Disability scores, alongside an analysis of how demographic and procedural variables associated with acute pain. The researchers collected a robust dataset by observing 80 operations, yielding a total of 970 intraoperative RULA scores. This high volume of data points allowed for a granular analysis of how posture shifts throughout a case. By comparing preoperative baselines to postoperative pain reports and real-time ergonomic assessments, the study maps the physical challenges inherent in otolaryngology. For practicing surgeons, these findings highlight the specific moments during routine operations where ergonomic risk reaches levels that may necessitate intraoperative adjustments or equipment redesign to prevent chronic disability.
High Prevalence of Ergonomic Risk
The analysis of intraoperative posture revealed a high prevalence of poor ergonomics across all levels of surgical experience. Among attending physicians, 143 of 386 RULA scores (37%) indicated medium to high ergonomic risk, defined as scores between 5 and 7. The physical burden was even more frequent among trainees, as 249 of 584 resident RULA scores (43%) reached the medium to high risk threshold of 5 to 7. These findings demonstrate that a significant portion of operative time is spent in positions that exceed safe physiological limits, even in an academic setting where ergonomic awareness might be expected to be higher. The data further suggest that the physical toll of surgery is cumulative and influenced by surgeon demographics. The researchers found that RULA scores increased with operative duration, reflecting a progressive decline in postural integrity as procedures continued. This escalation of risk was particularly evident among surgeons 40 years and older, who showed a greater tendency toward high-risk scores as cases progressed compared to their younger counterparts. Because these elevated risk levels were observed across 80 different operations, the study indicates that musculoskeletal strain is a constant factor in the surgical environment. It persists even during routine procedures that clinicians may not typically associate with high physical demand, underscoring the necessity for surgeons to implement ergonomic interventions early in their careers to mitigate the risk of long-term disability.
Predictors of Surgeon Discomfort
To identify the specific drivers of intraoperative strain, the researchers utilized mixed-effects modeling (a statistical technique that accounts for both fixed effects and random variations within a dataset, such as multiple observations from the same surgeon). The analysis revealed that greater case difficulty was associated with increased pain scores, suggesting that the heightened technical and cognitive demands of complex procedures translate directly into physical morbidity. Perhaps more unexpectedly, the modeling also showed that larger glove size was associated with higher pain scores. This finding suggests that surgeons with larger hands may experience unique ergonomic challenges when using standard otolaryngology instruments or navigating the narrow corridors of the head and neck, which are often optimized for smaller anatomical structures. While case complexity and hand size emerged as significant predictors, other demographic and procedural factors did not show a statistical link to postoperative discomfort. The study found that no significant associations were observed between pain scores and surgeon weight, sex, age, or training level. This lack of correlation indicates that the risk of musculoskeletal pain is a universal concern for the surgical workforce, affecting residents and attending physicians alike. Furthermore, no significant associations were observed between pain scores and the length or type of procedure. These data suggest that while postural risk may accumulate over time, the subjective experience of acute pain is driven more by the immediate physical demands of the task and individual anatomical factors than by the duration of the operation.
The physical strain documented in this study translated into tangible disruptions during surgical workflows, affecting both the comfort and the focus of the operative team. Postoperative surveys indicated that 23 of 80 procedures (28.8%) required intraoperative position changes due to discomfort. This suggests that in nearly one third of cases, surgeons actively attempted to mitigate acute musculoskeletal stress while operating. These adjustments represent a reactive attempt to manage pain that has already reached a threshold of clinical significance. In more severe instances, the physical burden necessitated a complete cessation of the task, as surgeons required a break due to discomfort in 2 of 80 procedures (2.5%). Beyond physical adjustments, the study highlighted the cognitive and technical toll of ergonomic strain on the surgeon. The researchers found that in 7 of 80 procedures (8.8%), surgeons reported distraction due to pain, a finding that suggests musculoskeletal discomfort competes with the high level of concentration required for intricate head and neck operations. Most critically, in 1 of 80 procedures (1.3%), pain was reported to interfere with surgical performance. While this represents a small percentage of the total cases, any instance where physical pain compromises technical execution poses a potential risk to patient safety and surgical outcomes. These findings underscore that ergonomic risk is not a theoretical concern but a daily reality that affects surgical precision and clinician well-being. Because the study demonstrated measurable increases in pain even during routine procedures, the authors emphasize the urgent need for targeted ergonomic training and equipment redesign. Addressing these factors, particularly the association between larger hand size and pain, is essential to preserve surgeon longevity and maintain the high standards of operative performance required in modern surgical practice.
References
1. Gorce P, Jacquier-Bret J. Continental Assessment of Work-Related Musculoskeletal Disorders Prevalence Among Surgeons: Systematic Review and Meta-Analysis. Journal of Functional Morphology and Kinesiology. 2025. doi:10.3390/jfmk10020221
2. Gorce P, Jacquier-Bret J. Effect of Assisted Surgery on Work-Related Musculoskeletal Disorder Prevalence by Body Area among Surgeons: Systematic Review and Meta-Analysis. International Journal of Environmental Research and Public Health. 2023. doi:10.3390/ijerph20146419
3. Balendran B, Bath M, Awopetu A, Kreckler S. Burnout within UK surgical specialties: a systematic review. Annals of The Royal College of Surgeons of England. 2021. doi:10.1308/rcsann.2020.7058
4. Basager A, Williams Q, Hanneke R, Sanaka A, Weinreich HM. Musculoskeletal disorders and discomfort for female surgeons or surgeons with small hand size when using hand-held surgical instruments: a systematic review. Systematic Reviews. 2024. doi:10.1186/s13643-024-02462-y
5. Ntiamoah P, Machuzak M, Gildea TR, Mehta AC. Ergonomics of bronchoscopy: good advice or a pain in the neck?. European Respiratory Review. 2023. doi:10.1183/16000617.0139-2023
