Noise Exposure in the Orthopedic Operating Room: A Scoping Review of Instrument-Related Noise Levels.

Introduction: Noise exposure in orthopedic operating rooms (ORs), particularly from power tools, poses potential risks to surgical staff and patients, including noise-induced hearing loss (NIHL). This scoping review quantifies noise exposure related to orthopedic instrument use and explores recommended guidelines. Methods: Using Covidence, PubMed was systematically searched for studies published between January 1990 and December 2023. Of 1671 initial studies, 13 met inclusion criteria. Data extracted included decibel measurements, instrument types, measurement distances, and noise exposure recommendations. Results: Unweighted decibel measurements for oscillating and reciprocating saws ranged from 81 dB to 131 dB, drilling systems from 78.3 dB to 97 dB, and hammering from 92 dB to 103.4 dB. A-weighted measurements for saws ranged from 53 dB(A) to 100 dB(A), drilling systems from 74.6 dB(A) to 97 dB(A), rasping systems from 87 dB(A) to 110 dB(A), and acetabular reaming at 87 dB(A). Action value set by the UK Control of Noise at Work Regulations, begin at 80 dB(A), requiring information, training, and hearing protection, while the upper exposure action value is 85 dB(A), mandating noise reduction measures and enforce hearing protection use. Of the included studies, 61.5% (8 of 13) provided explicit noise mitigation recommendations, 23.1% (3 of 13) presented mixed recommendations, and 15.4% (2 of 13) found no significant risk. Conclusion: Significant variation exists in reported exposure levels and recommendations, highlighting the need for standardized evaluation methodologies. Future research should focus on standardizing measurement parameters and comprehensively evaluating current instrumentation to develop evidence-based noise mitigation protocols for orthopedic ORs.