Reproductive Hazards in the OR Need More Attention: Review

By Reuters Staff

January 08, 2020

NEW YORK (Reuters Health) - Hospitals must take steps to control exposure to reproductive hazards in the surgical workplace, according to the authors of a new review.

Female surgeons face higher rates of pregnancy complications and infertility than women in the general population, Dr. Matilda Anderson of Western Health Surgical Department, in Footscray, Australia, and Dr. Rose H. Goldman of Harvard Medical School, in Boston, note in JAMA Surgery.

While the fact that woman surgeons have their first child later, on average, than the general population may be a contributing factor, the authors add, "the association of occupational reproductive hazards with infertility and pregnancy complications in this population has not been adequately explored or defined."

They discuss potential reproductive hazards in operating rooms, including radiation, surgical smoke, working conditions, sharps injury, anesthetic gases and toxic agents used interoperatively, and make evidence-based recommendations for reducing exposure.

Steps the authors list to limit radiation exposure include adhering to ALARA ("as low as reasonably achievable radiation exposure") principles, mandating use of personal protective garments or shielding, and requiring pregnant women to use a fetal dosimeter and be checked monthly.

While no studies have looked at the reproductive effects of surgical-smoke exposure, Dr. Anderson and Dr. Goldman note, individual smoke components have been linked to infertility and worse maternal and fetal outcomes.

They recommend installing and maintaining ventilating systems in operating rooms, mandating smoke evacuation rather than room suction, and considering the use of high filtration masks during standard surgery and N95 respirators for operations that generate aerosols.

The authors also state that both male and female surgeons actively trying to conceive should avoid working in operative settings where hyperthermic intraperitoneal chemotherapy (HIPEC) is being used.

"At a minimum, workplaces need to comply with existing guidelines or standards, recognizing that these may not be protective for reproductive outcomes, and so that it may be wise to do more. Alternative work duties and/or conditions should be readily available. Priority should be given to controlling exposure rather than restricting surgeons' activity," the authors state.

"Given the limited data regarding operating room hazards and reproductive outcomes, as well as introduction of new operating room environmental exposures, more research is needed to define their reproductive effects, as well as effective and practical interventions to reduce exposure. In addition, prospective studies of women of reproductive age are needed to measure exposure levels and accurately record pregnancy outcomes," they conclude.

SOURCE: JAMA Surgery, online January 2, 2020.