A Quantitative Analysis of Surgical Smoke Derived Particulate Matter and Formaldehyde (HCOH) Exposure During Spine Surgery; A Possible Occupational Hazard

Introduction: Since its introduction, electrocautery has served as a valuable surgical tool, enabling precise tissue cutting and effective hemostasis in spinal surgery. While there have been numerous efforts to elucidate the possible hazardous effects of surgical smoke in various surgical fields, there has been very little discussion in the context of spinal surgery.
The objective of this study is to measure and conduct a quantitative analysis of the particulate matter (PM) of different sizes and formaldehyde (HCOH) generated by surgical smoke during spinal surgeries.

Methods: This study included a consecutive series of patients who underwent one- or two-level lumbar spinal fusion surgery between June 2021 and November 2021. Particle counts were measured using a particle counter, specifically focusing on six different sizes of PM (0.3μm to 10μm). Additionally, measurements were taken for HCOH in parts per million (ppm). Monopolar cautery was employed in the surgical setting. Systematic measurements were conducted at specific time points during the surgical procedures to assess the levels of PM and HCOH. Furthermore, the efficacy of surgical smoke suction was evaluated by comparing the PM levels with and without adjacent placement of suction.

Results: This study involved a total of 35 patients, with measurements of both PMs and HCOH taken in 27 cases. The remaining 8 cases had measurements only for PMs. In this study, statistically significant quantitative changes in various sizes of PMs were observed when electrocautery was used during spinal surgery. [12.3±1.7 vs 1975.7±422.8, 3.4±0.5 vs 250.1±45.7, and 1.9±0.2 vs 78.1±13.3 respectively for PM 2.5, 5, and 10 (p < 0.05)] The level of HCOH was also significantly higher [0.085 ± 0.006 vs 0.131 ± 0.014 ppm (p < 0.05)] under use of electrocautery. Utilization of adjacent suction of surgical smoke during electrocautery demonstrated a statistically significant reduction in PMs levels.

Conclusion : The findings of this study highlight the potential surgical smoke related hazards that spinal surgeons may be exposed to in the operating room. Implementing simple interventions, such as utilizing nearby suction, can effectively minimize the amount of toxic surgical smoke and mitigate the risks.