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The utility of local smoke evacuation in reducing surgical smoke exposure in spine surgery: a prospective self-controlled study.
Spine J 2019SJ

Abstract

BACKGROUND CONTEXT

Exposure to surgical smoke remains a potential occupational health concern to spine operating room personnel. Using a smoke evacuator (local exhaust ventilation) is currently regarded as a primary means of protection, yet few studies have evaluated its utility in actual surgeries.

OBJECTIVE

To examine the utility of two common types of local smoke evacuators, a para incisional evacuator and a smoke evacuation pencil, in reducing surgical smoke exposure in spine surgery.

STUDY DESIGN

A prospective self-controlled study.

PATIENT SAMPLE

After the pre-estimation of sample size, 51 consecutive spine surgeries (25 and 26 patients using the para incisional smoke evacuator and the smoke evacuation pencil, respectively) were enrolled between February 2018 and March 2019.

OUTCOME MEASURES

Two outcome measures were used to evaluate the level of surgical smoke exposure, which was defined as the concentration of ultrafine smoke particles in the air (number of particles per cm3, ppc) around the operating table: (a) the average smoke level was the arithmetic mean of all measurements recorded during the surgery; and (b) the peak smoke level was the highest measurement recorded.

METHODS

Consecutive surgeries that involved bilateral symmetrical surgical exposure of the spine via a posterior midline incision were evaluated. Cauterized smoke was evacuated by two smoke evacuators: a "para incisional evacuator," which used a flat broad suction pad positioned immediately adjacent to the incision (25 patients), and a "surgical smoke evacuation pencil" which is an incorporated part of the electrocautery (26 patients). The level of smoke exposure was measured separately when surgically exposing the two sides of the spine: starting with one side (determined randomly) with the smoke evacuator being turned on and, then, the other side with the smoke evacuator off. The results were compared between the two sides.

RESULTS

The para incisional smoke evacuator significantly reduced the average smoke level by an average of 59.7% (287 [interquartile range {IQR}: 126, 526] vs. 1,177 [IQR: 395, 2,702], p<.001). The surgical smoke evacuation pencil also reduced the average smoke level by an average of 44.1% (917 [IQR: 448, 1936] vs. 1,605 [IQR: 775, 4,280], p<.001). Both evacuators significantly reduced peak smoke levels as well.

CONCLUSIONS

This study provides evidence supporting the utility of local smoke evacuation in reducing surgical smoke exposure in spine surgery. Such technology may help to improve the occupational health protection for spine operating room workers.

Authors+Show Affiliations

Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA.BSI, Environmental, Health, and Safety Services and Solutions, San Jose, CA, USA.Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA. Electronic address: kbwood@stanford.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31542472

Citation

Liu, Ning, et al. "The Utility of Local Smoke Evacuation in Reducing Surgical Smoke Exposure in Spine Surgery: a Prospective Self-controlled Study." The Spine Journal : Official Journal of the North American Spine Society, 2019.
Liu N, Filipp N, Wood KB. The utility of local smoke evacuation in reducing surgical smoke exposure in spine surgery: a prospective self-controlled study. Spine J. 2019.
Liu, N., Filipp, N., & Wood, K. B. (2019). The utility of local smoke evacuation in reducing surgical smoke exposure in spine surgery: a prospective self-controlled study. The Spine Journal : Official Journal of the North American Spine Society, doi:10.1016/j.spinee.2019.09.014.
Liu N, Filipp N, Wood KB. The Utility of Local Smoke Evacuation in Reducing Surgical Smoke Exposure in Spine Surgery: a Prospective Self-controlled Study. Spine J. 2019 Sep 19; PubMed PMID: 31542472.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The utility of local smoke evacuation in reducing surgical smoke exposure in spine surgery: a prospective self-controlled study. AU - Liu,Ning, AU - Filipp,Nick, AU - Wood,Kirkham B, Y1 - 2019/09/19/ PY - 2019/06/19/received PY - 2019/09/13/revised PY - 2019/09/16/accepted PY - 2019/9/23/pubmed PY - 2019/9/23/medline PY - 2019/9/23/entrez KW - Exposure control KW - Local evacuation ventilation KW - Smoke evacuator KW - Spine surgery KW - Surgical smoke KW - Surgical smoke pencil JF - The spine journal : official journal of the North American Spine Society JO - Spine J N2 - BACKGROUND CONTEXT: Exposure to surgical smoke remains a potential occupational health concern to spine operating room personnel. Using a smoke evacuator (local exhaust ventilation) is currently regarded as a primary means of protection, yet few studies have evaluated its utility in actual surgeries. OBJECTIVE: To examine the utility of two common types of local smoke evacuators, a para incisional evacuator and a smoke evacuation pencil, in reducing surgical smoke exposure in spine surgery. STUDY DESIGN: A prospective self-controlled study. PATIENT SAMPLE: After the pre-estimation of sample size, 51 consecutive spine surgeries (25 and 26 patients using the para incisional smoke evacuator and the smoke evacuation pencil, respectively) were enrolled between February 2018 and March 2019. OUTCOME MEASURES: Two outcome measures were used to evaluate the level of surgical smoke exposure, which was defined as the concentration of ultrafine smoke particles in the air (number of particles per cm3, ppc) around the operating table: (a) the average smoke level was the arithmetic mean of all measurements recorded during the surgery; and (b) the peak smoke level was the highest measurement recorded. METHODS: Consecutive surgeries that involved bilateral symmetrical surgical exposure of the spine via a posterior midline incision were evaluated. Cauterized smoke was evacuated by two smoke evacuators: a "para incisional evacuator," which used a flat broad suction pad positioned immediately adjacent to the incision (25 patients), and a "surgical smoke evacuation pencil" which is an incorporated part of the electrocautery (26 patients). The level of smoke exposure was measured separately when surgically exposing the two sides of the spine: starting with one side (determined randomly) with the smoke evacuator being turned on and, then, the other side with the smoke evacuator off. The results were compared between the two sides. RESULTS: The para incisional smoke evacuator significantly reduced the average smoke level by an average of 59.7% (287 [interquartile range {IQR}: 126, 526] vs. 1,177 [IQR: 395, 2,702], p<.001). The surgical smoke evacuation pencil also reduced the average smoke level by an average of 44.1% (917 [IQR: 448, 1936] vs. 1,605 [IQR: 775, 4,280], p<.001). Both evacuators significantly reduced peak smoke levels as well. CONCLUSIONS: This study provides evidence supporting the utility of local smoke evacuation in reducing surgical smoke exposure in spine surgery. Such technology may help to improve the occupational health protection for spine operating room workers. SN - 1878-1632 UR - https://www.unboundmedicine.com/medline/citation/31542472/The_utility_of_local_smoke_evacuation_in_reducing_surgical_smoke_exposure_in_spine_surgery:_a_prospective_self-controlled_study L2 - https://linkinghub.elsevier.com/retrieve/pii/S1529-9430(19)30997-0 DB - PRIME DP - Unbound Medicine ER -