Influence of two different operating room ventilation systems on the surgical smoke exposure of surgeons

Abstract

The intraoperative use of electrosurgical devices leads to the emission of surgical smoke, which is a proven health risk for operating room personnel. According to guidelines, either a unidirectional displacement flow system or mixed turbulent flow ventilation are recommended to reduce the surgical smoke exposure. However, the impact of the ventilation system on the particle concentration in clinical practice remains unclear. We performed a multicenter study and first investigated the turbulence intensity (for unidirectional displacement flow) and the recovery time (for mixed turbulent flow) in 15 operating rooms. Then, particle concentrations sized ≥0.3 μm were measured in the surgeons’ breathing zones and the 5th percentile, the mean, the 95th percentile, and the maximum concentration were determined. The average particle concentrations during 179 surgical procedures (unidirectional displacement flow: n = 87 surgeries; mixed turbulent flow: n = 92 surgeries; median time from skin incision to suture: 70 min; median electrocautery time: 24%/16.8 min) were 1.5 E+05/m³ (5th percentile), 1.7 E+06/m³ (mean), 2.5 E+07/m³ (95th percentile), and 2.1 E+08/m³ (maximum). Unidirectional displacement flow ventilation systems with turbulence intensities ≤5% decreased the particle concentration by a factor of 5.3 for the 5th percentile, 2.1 for the mean, 5.7 for the 95th percentile, and 6.6 for the maximum concentration compared to unidirectional displacement flow systems with turbulence intensities ≥20%. Furthermore, a turbulence intensity ≤5% reduced particles 15.5-times (5th percentile), 8.6-times (mean), 8.4-times (95th percentile), and 6.4-times (maximum) more effective than mixed turbulent flow ventilation. We concluded that the ventilation system has a relevant quantitative effect on the particle concentration, especially if electrocautery devices are used. A unidirectional displacement flow system with a turbulence intensity ≤5% reduced particles best, while mixed turbulent flow ventilation is not optimal for surgeries with surgical smoke release. Operating room personnel should be aware that even a short period of electrocautery application can cause high concentrations of surgical smoke particles. Thus, electrocautery devices should always be used with caution.