Surgical smoke (SS) created by thermal destruction of tissue poses a health hazard to surgical staff. While SS evacuation technology exists, its use at Michigan Medicine is not mandated; a preliminary survey found that it is used in less than two-thirds of cases. This study was conducted to further characterize usage of SS evacuation technology and perceived barriers to their use among surgeons at Michigan Medicine, with the aim of guiding development of an improved device.
Data were collected via Qualtrics. Subjects included medical students and physicians in the Department of Surgery at Michigan Medicine. Analysis was conducted in R. We conducted bivariate analyses assessing associations between demographic and outcome variables using Pearson’s Chi-square tests. We then constructed a multinomial regression model for factors associated with use of smoke evacuation devices.
Of 105 respondents, 53.3% were somewhat or strongly concerned about SS as a health hazard. Half of respondents (49.4%) reported using SS evacuation devices “most” or “all of the time,” 22.5% reported using them “about half the time,” and 28.1% reported using them “rarely” or “never.” The most commonly indicated barriers to using these devices were their bulkiness (n=50), noise produced (n=39), impact on visualization (n=38), and inadequacy of smoke evacuation (n=32). Two-thirds (66.3%) of respondents reported having received no formal training regarding SS exposure hazards and evacuation devices. Only 36.5% of participants reported that smoke evacuators were available in their ORs all of the time. We found significant associations between the level of concern regarding SS as a health hazard and perceived benefit of smoke evacuation devices across multiple groups (p<0.01). Additionally, perceived smoke evacuator availability is a significant predictor of greater use (p<0.01), and certain surgical subspecialties were significant predictors of specific barriers to using smoke evacuation devices (p=0.02).
Further studies are needed to better understand the differences in attitudes and use observed among different groups. However, creation of a quieter, slimmer device with improved suctioning power, as well as improved training and device availability, may increase utilization of OR smoke evacuation.