W.M. Oslock1,2, G.A. Baker3, S. Stowe4, A. Abbas1, G.C. Hernández Márquez1, M.S. Morris1, D.I. Chi1, R. Vilcassim4 1University Of Alabama at Birmingham, Surgery, Birmingham, Alabama, USA 2Birmingham Veterans Affairs Medical Center, Quality, Birmingham, AL, USA 3University Of Alabama at Birmingham, School Of Medicine, Birmingham, Alabama, USA 4University Of Alabama at Birmingham, School Of Public Health, Birmingham, Alabama, USA
Introduction: Surgical smoke is generated by many devices used during surgery, most notably electrocautery. The smoke generated includes harmful air pollutants like particulate matter and volatile organic compounds (VOCs). However, gaps remain in understanding the exposure experienced by operating room staff. In this study we aimed to evaluate the role of smoke evacuators on air pollutant exposure concentrations during procedures with frequent electrocautery use.
Methods: Surgical smoke concentrations were measured during breast and amputation operations at an academic institution that does not require smoke evacuators. Operation, operating room, smoke evacuator use, and 1-min observations of electrocautery use were recorded. Particulate matter less than 2.5μm in diameter (PM2.5) concentrations were measured via a PDR-1500 DataRAM air monitor that provided average measurements per minute both near the surgical field and at the periphery of the room. Total VOC levels were measured near the source of surgical smoke and anesthetic gases. Cases were stratified by smoke evacuator presence. Peak and average levels were calculated and analyzed with t-tests and chi-square tests.
Results: In total, 10 cases were included, most commonly mastectomies (n=6, 60%). The majority of cases did not use a smoke evacuator (n=6) and electrocautery was used an average of 58.6min. Near the field, average PM2.5 was higher without smoke evacuators (28.3 vs 4.3µg/m3, p<0.0001). Similarly, at the periphery, average PM2.5 was higher in the absence of smoke evacuators compared to when smoke evacuators were present (3.8 vs 1.1µg/m3, p<0.0001). This was reflected in total time spent at elevated levels (Figure) with cases without smoke evacuators spending 6.8% of their time (min) >100µg/m3, 12.5% from 50-100µg/m3, and 11.0% 25-50µg/m3 (p<0.001). In contrast, cases with smoke evacuators spent <3 minutes at concentrations >25µg/m3. Number and severity of PM2.5 peaks also varied with 29 peaks >50 and a max of 301 µg/m3 for cases without smoke evacuators vs only a single peak and a max of 61.4 µg/m3 during a surgery with a smoke evacuator. In contrast, during electrocautery VOC levels were higher with a smoke evacuator (22384 ppb vs 18015, p<0.0001) and an average concentration of 3052 vs 1191ppb with vs without a smoke evacuator, respectively.
Conclusion: Our initial study of air pollutant levels within surgical smoke demonstrated significantly higher average PM2.5 levels during electrocautery use without a smoke evacuator. More concerning were the severe and frequent peaks in PM2.5. Further studies are needed to understand exposure levels with variable levels of electrocautery use as well as particulate matter composition to allow for better risk stratification.