Poor Ergonomics During Surgery Increase Musculoskeletal Injury Risk

by Literature Review •

What ergonomic challenges in postural-related strain and musculoskeletal discomfort exist among otolaryngology surgeons, and what ergonomics training and equipment are available to them?

Bottom Line
Pain and disability induced by poor ergonomics are widespread among the otolaryngology community, and surgeons rarely receive ergonomic training in the surgical context. The majority of observed surgeons displayed poor posture, particularly a poor cervical angle and use of ergonomic setups, both of which increase ergonomic risk hazard.

Background: On average, surgeons spend approximately 2,500 hours working per year, with up to a third of those hours spent in the OR. This activity level can take a toll on the surgeons’ musculoskeletal (MSK) system, particularly as a result of prolonged poorly compensated postural load and absences of good ergonomic practice in the OR. Globally, between 47% to 74% of responding otolaryngology surgeons report some degree of pain or discomfort directly attributed to poor ergonomic positioning during work.

Study design: Intraoperative observations and survey study of 70 otolaryngology surgeons, including attending staff, fellows, and residents.

Setting: Stanford University School of Medicine, Palo Alto, Calif.

Synopsis: The response rate was 68.6% (48 of 70). A total of 35 respondents reported significant discomfort during surgery. Over half of respondents assumed a standing position during surgery, especially during open surgical technique. No respondents assumed a standing position during microscopic surgery; endoscopic procedures were done both standing or seated. The most common area of MSK discomfort was in the cervical spine, both standing and seated. Limb pain was similar in both seated and standing positions. Thirteen respondents reported no pain. Standing during surgery was most associated with back pain, and was significantly associated with cervical pain. Other activities contributing to back pain were sitting during surgery, and sitting and standing in the clinic. Most respondents experienced pain during work either less than once per week or less than two times per week. The average back pain severity during surgery or in the clinic was 2.2 of 10; the peak average back pain severity was 3.3 of 10. Approximately half of respondents stated that MSK pain did not affect their work; 14 reported a mild effect. Fifteen respondents were mildly affected and 10 were moderately affected by MSK pain outside of work. Of those, 21 of 45 respondents reported access to adjustable surgical chair/stools with armrests. Using Rapid Entire Body Assessment (REBA) on surgical photos, eight scores for standing surgery were at high risk of injury, 15 were at medium risk, and four were at low risk. In the seated group, none were at high risk, eight were at medium risk, and three were at low risk. For standing surgery, the greatest REBA risk factor was inappropriate table height. Others included awkward postures, excessive repetition, use of excessive force, static exertions, and vibration. Limitations included the small sample size from a single institution, the subjective nature of REBA scoring, and lack of information on predisposing injury factors.

Citation: Vaisbuch Y, Aaron KA, Moore JM, et al. Ergonomic hazards in otolaryngology. Laryngoscope. 2019;129:370–376.