Study Identifies Operating Room Toxins as Possible COPD Risk Factor

Long-time exposure to operating room chemicals may significantly increase one’s risk of developing chronic obstructive pulmonary disease (COPD), according to a recent study published in JAMA Network Open.

Disinfectants and surgical smoke are gaseous by-products produced by heat-generating surgical instruments, exposing physicians, nurses, and other hospital staff during electrosurgery and laser procedures in operating rooms (OR).

Focusing on nurses, results found that COPD risk among these nurses varied by nursing job type and duration in the OR. Nurses who worked in the OR for 15 or more years were 69% more likely to develop COPD, compared with nurses who had never worked in an OR and worked in an administrative or nursing education role, or a non-nurse job.

The study is the first to assess the role of occupational exposure to surgical smoke and COPD risk.

The work was an international collaboration with researchers led by Boston University School of Public Health; Harvard Medical School; Brigham and Women’s Hospital; and Inserm National French Institute of Health and Medical Research. It was funded by the National Institutes of Health and Ethicon, a subsidiary of the Johnson & Johnson Medical Devices Companies.

For the study, researchers analyzed data on OR employment history and COPD incidence among a cohort of 75,011 nurses working in US hospitals in 1984. The participants are part of the NIH-funded Nurses’ Health Study (NHS), an ongoing, prospective study of more than 121,000 US female nurses ages 30-55 who have completed biennial questionnaires since 1976. OR employment duration served as a proxy for nurses’ exposure to inhaled agents, and the study adjusted for primary COPD risk factors such as cigarette smoking and chronic disease.

Compared with nurses who had no OR employment and worked in administrative or nursing education roles, or in a non-nurse job, the study found that inpatient and outpatient nurses had higher risks (31% and 24%, respectively) of developing COPD, and nurses with less than 15 years of OR experience had a 22% higher risk. When comparing OR nursing employment only, OR employment for 15 or more years was associated with a 46% increased risk of nurses developing COPD compared with nurses with no OR employment.

Although the study data reflects working conditions in the OR during the 1980’s, the findings are applicable to today’s OR environment, the researchers said. Disinfectant use has increased over the past decades, and there is little evidence that the hazard of surgical smoke has reduced.

“Smoke-generating laparoscopic surgery is performed in a broader range of procedures, and protective surgical masks, such as the N95 mask, cannot block the small particulates in surgical smoke,” study lead author Wubin Xie, postdoctoral association in the Department of Global Health at the Boston University School of Public Health, said in a statement. Moreover, smoke evacuation systems, which capture smoke aerosols and gases emitted during procedures, have not been implemented in many operating rooms.

Reference

Xie W, Dumas O, Varraso R, et al Association of occupational exposure to inhaled agents in operating rooms with incidence of chronic obstructive pulmonary disease among US female nurses. JAMA Netw Open. Published online September 20, 2021. doi:10.1001/jamanetworkopen.2021.25749