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Surgical Smoke Exposure in Operating Room PersonnelA Review

Educational Objective To state the potential hazards of surgical smoke.
1 Credit CME

Importance  Smoke generated during surgical procedures has long been thought to be hazardous to hospital personnel; however, the degree of danger has yet to be determined.

Observations  The dangers of surgical smoke are associated with the composition of the plume. Small-particulate matter is found in the smoke that is easily inhaled. Particulates deposit in the lungs, circulatory system, and other organs, which may cause numerous health problems. The smoke also contains many gaseous compounds known to cause cancer. The type of tissue and the form of cautery have been shown to alter the composition of the surgical smoke. Well-cited articles have asserted that daily inhaled surgical smoke could be equivalent to smoking dozens of cigarettes. Unsafe levels of cancer-causing compounds have been found in the smoke. However, there is no firm evidence that operating room personnel show increased cancer rates compared with the general population. Data implicating other forms of passively inhaled smoke, such as fumes associated with cooking and wood burning, are likely comparable to the smoke issued during surgical procedures. Most operating rooms do not require smoke evacuation, and the elimination techniques are variable. Most systems rely on dispersion and, possibly, mechanical evacuation and filtration. Newer electric filters show promise but require more development.

Conclusions and Relevance  Surgical smoke is dangerous, but the severity of the risk has yet to be determined. Therefore, no safe level is known at this point. Efforts should be made to reduce and possibly eliminate smoke from the operating room. Research into cost-effective forms of smoke evacuation is necessary. Studies of respiratory and cancer sequelae of exposure to operating room smoke in personnel who have had long-term exposure to surgical smoke is also needed.

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Article Information

Accepted for Publication: May 27, 2019.

Corresponding Author: Kurt A. Melstrom, MD, Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, 1500 E Duarte Rd, Duarte, CA 91010 (kmelstrom@coh.org).

Published Online: August 21, 2019. doi:10.1001/jamasurg.2019.2515

Author Contributions: Dr Melstrom had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Melstrom, Fong.

Acquisition, analysis, or interpretation of data: Limchantra.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: Melstrom, Limchantra.

Statistical analysis: Limchantra.

Administrative, technical, or material support: Melstrom.

Supervision: Melstrom, Fong.

Conflict of Interest Disclosures: Dr Fong reported serving as a paid scientific advisor to Medtronics, Johnson and Johnson, and Olympus, with no work on smoke evacuation included. No other disclosures were reported.

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