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Intraoperative Electrosurgical Smoke During Outpatient Surgery: A Survey of Dermatologic Surgeon and Staff Preferences

Cutis. 2019 August;104(2):120-124
August 9, 2019|Cutis
Nicholas Golda, MD;Brandon Merrill, MD;Brett Neill, MD
Author and Disclosure Information

Drs. Golda and Merrill are from the Department of Dermatology, University of Missouri Hospitals and Clinics, Columbia. Dr. Neill is from the University of Missouri School of Medicine.

The authors report no conflict of interest.

Correspondence: Brandon Merrill, MD, Department of Dermatology, University of Missouri Hospitals and Clinics, 1 Hospital Dr, Rm MA111, Columbia, MO 65212 (merrillbp@health.missouri.edu).

Electrosurgery generates smoke that may be harmful. We created a survey to evaluate perceptions of electrosurgical smoke and how information on the harm it potentially causes changes these perceptions. We distributed the survey to the membership of the American College of Mohs Surgery and the American Society for Dermatologic Surgery and received 437 useable responses. Results indicated that many dermatologic surgeons were aware of and bothered by surgical smoke, and these reactions were more prevalent after being educated on the potential hazards of electrosurgical smoke.

Practice Points

  • Growing evidence suggests that the surgical smoke plume generated during electrosurgery may be harmful if inhaled.
  • Our survey indicates that this information may affect clinician and staff perceptions about exposure to electrosurgical smoke and its remediation.

Results

There was a total of 443 responses to our questionnaire. Two respondents answered that they did not work in an office where skin surgery was performed, and 4 respondents did not answer any questions and were therefore excluded, leaving a total of 437 responses (402 physicians and 35 staff members). A summary of the characteristics of the respondents is shown in the Table. Some respondents did not answer each question, leading to fewer than 437 answers for some questions.

Two hundred eighty-two respondents (64.5%) never or very rarely used smoke evacuation during skin surgical procedures, and only 85 (19.5%) used smoke evacuation with nearly every case. The remaining respondents sometimes used smoke evacuation (Figure 1).

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Figure 1. Responses for question “Does your office use smoke evacuation during skin surgery?”

Prior to being presented with the potential dangers of electrosurgical smoke and using a value of 5 to 10 to determine if respondents noticed smoke, 54.4% (95% CI, 49.5%-59.1%) did notice intraoperative smoke during procedures. Using a value of 5 to 10 to indicate if respondents were bothered or troubled by the smoke smell, 35.5% (95% CI, 31.0%-40.2%) were bothered or troubled by intraoperative smoke prior to potential hazards being presented.

Regarding acceptable increase in cost per procedure for smoke evacuation at baseline, 68.9% of respondents favored additional cost; 57.8% of respondents chose the lowest cost grouping of $1 to $30. After being presented with information about the potential harm of intraoperative smoke, the respondents in favor of additional cost increased to 71.5%, which was a small but statistically significant change (P=.0075)(Figure 2).

Figure 2. Responses for question “How much additional cost per procedure do you think would be acceptable to have the smoke smell eliminated in your work environment?” (overall change in response following intervention across all response ranges, P=.0075).

Respondents were sorted into groups consisting of those who never used smoke evacuation, those who used it occasionally, and those who used it with all smoke-producing procedures. The degree to which respondents noticed intraoperative smoke was strongly correlated with their use of smoke evacuation; those who never used smoke evacuation noticed the presence of smoke more, and those who always used smoke evacuation noticed it less (P=.0002). Similar trends were noted regarding if the smoke smell bothered or troubled respondents (P=.0014).

After being presented with the potential risks of electrosurgical smoke, 29 more respondents answered that they were severely bothered by electrosurgical smoke, whereas 45 fewer respondents selected that they were not bothered or troubled at all by electrosurgical smoke (Figure 3). This difference was statistically significant (P<.0001). Fifteen more respondents answered that they would be much more likely to choose to work at a practice with smoke evacuation once the potential harm of electrosurgical smoke was introduced, and 11 were somewhat more likely to choose a practice with smoke evacuation (P<.0001).

Figure 3. Responses for question “Did the smoke smell bother or trouble you in any way?” (overall change in response following intervention across all response ranges, P<.0001).

Information about the potential harm of electrosurgical smoke did not statistically significantly affect satisfaction with work environment (P=.3139)(Figure 4).

Figure 4. Responses for question “If the smoke smell could be reduced or eliminated completely, would that make you more satisfied with your work environment?” (overall change in response following intervention across all response ranges, P=.3139).

There were no statistically significant differences between surgeon and staff responses on any questions.

Comment

Developing evidence of health risks associated with electrosurgical smoke plumes has led to an increasing interest in the use of smoke protection or remediation tools during surgical procedures. High-filtration face masks and smoke-evacuation devices protect physicians, staff members, and patients, as well as improve the patient’s clinical experience.

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