As a major leading cause of morbidity and mortality all over the world, chronic obstructive pulmonary disease is an important target for research in prevention and management. Although it has been most strongly linked to smoking tobacco, occupational exposures are also a significant risk factor for the development of COPD [3]. One such category of occupational exposures includes chemicals and gases that are found in the OR and other healthcare settings, and so it is possible that healthcare workers that spend significant time in the OR on a regular basis are at a higher risk for the development of COPD [3].
Surgical smoke has a well-documented risk profile, and it most commonly occurs after electrocautery ablation and laser ablation [1]. It releases a host of mutagens and carcinogens into the OR, including ethyl benzene, aldehydes, toluene and xylene [1]. The liver is by far the largest producer of surgical smoke, followed by skeletal muscle and renal tissue [1]. The larger particulates deposit on the trachea, larger bronchi and nasopharynx when inhaled, while the smaller particulates deposit in the bronchioles and alveoli [1]. In addition to COPD, the damage caused by these particulates also leads to an increased risk of lung cancer, persistent asthma, pneumonia and other respiratory tract infections [1].
A 2021 study published in JAMA looked at this association in a larger population than had ever previously been done, using data from the Nurses’ Health Study [3]. Nurses in the OR have the highest self-reported disinfectant use in healthcare and also have significant exposure to surgical smoke [3]. Roughly 75,000 nurses were followed in this study, and it showed that increased COPD risk is associated with OR employment histories of greater than 15 years [3]. Cleaning products and disinfectants used in the OR have in the past been linked to increased risk of COPD in occupational cleaners, but the risk was higher in people with OR employment histories, hypothesized to be due to the synergistic effect of surgical smoke and disinfectant exposure [3].
These risks highlight the importance of adequate protection for OR workers. Surgical masks have been shown to not have adequate filters against toxic particulates from surgical smoke; N95s and N100s were far more effective [2]. With heavier duty masks however, there are some reported subjective symptoms such as lightheadedness and headache [2]. Furthermore, using HEPA filters with activated carbon, proper ventilation and a smoke evacuation system can help reduce exposure to toxic chemicals, though use of the latter is somewhat controversial due to inadequate evidence that these systems can evacuate volatile compounds [1].
Overall, the extent to which exposure to the OR is a risk factor for COPD has not been adequately studied and is an important topic to inform preventative screening guidelines. Regardless, surgical smoke has been shown to be a risk factor for other pulmonary disorders, and people who work in the OR should properly protect themselves from this exposure as well as inform their primary care providers so that their pulmonary function can be monitored over time.
References
1. Liu Y, Song Y, Hu X, Yan L and Zhu X. Awareness of surgical smoke hazards and enhancement of surgical smoke prevention among gynecologists. Journal of Cancer 2019; 10(12): 2788-2799. PMID: 31258787
2. Wambier CG, Lee KC, Oliveira PB, Wambier SPF, Beltrame FL. Comment on “Surgical smoke: Risk assessment and mitigation strategies” and chemical adsorption by activated carbon N95 masks. Journal of the American Academy of Dermatolology. 2019; 80:79–80. doi: 10.1016/j.jaad.2018.10.067
3. Xie X, Dumas O, Varraso R, Boggs KM, Camargo CA, Stokes AC. Association of Occupational Exposure to Inhaled Agents in Operating Rooms With Incidence of Chronic Obstructive Pulmonary Disease Among US Female Nurses. JAMA Network Open 2021; 4(9): 1-11. doi: 10.1001/jamanetworkopen.2021.25749