A Randomized Controlled Trial of Ergonomic Risk in Pediatric Adenotonsillectomy

This study aims to compare the intraoperative ergonomics of tonsillectomies and adenoidectomies performed in seated versus standing positions for pediatric otolaryngology residents and attending physicians.

A randomized controlled trial.

A tertiary care center.

Intraoperative data were collected for 2 attending physicians and 13 residents as they performed adenoidectomies and tonsillectomies. Each tonsillectomy was randomized to either first tonsil sitting/second tonsil standing or vice versa. Adenoidectomies performed during the same anesthesia were performed in the second of the 2 positions, and thus also randomized. Isolated adenoidectomies were randomized to either the sitting or standing position. The rapid upper limb assessment (RULA) was used to quantify ergonomic risk for each operation on a 0 to 7 scale.

Univariate analysis demonstrated a significant difference between sitting and standing positions (P < .001), with the sitting position exhibiting lower mean total RULA scores (mean = 3.26, median = 3.00) compared to standing (mean = 3.76, median = 4.00). This was confirmed using a multi-variable analysis adjusting for demographic variables. Univariate analysis showed that PGY1 residents had the lowest total RULA scores, whereas attending physicians had the highest total RULA scores. However, this was not confirmed by multi-variable analysis. Upper arm, lower arm, and trunk body region scores were higher in the sitting position, while wrist and neck scores were higher in the standing position. These conclusions were drawn from both univariate and multi-variable analysis.

Sitting during adenotonsillectomy may mitigate ergonomic risk. Further research is needed to identify ways in which intraoperative ergonomics can be optimized. This study may also have implications for similar intraoral procedures.