Occupational Reproductive Hazards for Female Surgeons in the Operating Room

Abstract

emale surgeons have been found to have high rates of adverse pregnancy outcomes and infertility. [1][2][3] A survey of 1021 US female surgeons across different specialties found an overall pregnancy complication rate of 35.3%, compared with 14.5% in the general population. 3 Other studies support this finding, with a complication rate of 25.3% identified in a survey of 163 female urologists. 2 High infertility rates in surgeons have also been described. 1,3,4 A total of 32% of respondents to the 2012 survey reported difficulty with fertility compared with 10.9% of the general population. 3 These findings are increasingly significant with female representation in the surgical workforce rising. In the United Kingdom, women now compose 11.1% of consultant surgeons compared with 3% in 1991. 5 In the United States, 20.6% of general surgeons are women compared with 13.6% 10 years ago. 6,7 Female surgeons are having children at an older age: average age at delivery of their first child reported in the 2012 survey was 33 years, compared with 26 years in the general population. 3,8 Advancing maternal age is a risk factor for infertility and adverse pregnancy outcomes, but the extent of the role of age in complication rates in surgeons is difficult to determine. Although older than the comparison population, the female surgeons' average age at first delivery is younger than 35 years, which is traditionally considered the cutoff for advanced maternal age. 9 The association of occupational reproductive hazards with infertility and pregnancy complications in this population has not been adequately explored or defined. Operating room reproductive hazards are summarized in Table 1. Observations RadiationExposure to radiation in the operating room occurs via use of radioactive tracers and imaging techniques that aid surgical procedures. The use of intraoperative radiation is increasing, including development of hybrid operating rooms, which use fixed imaging, such as C-arms and computed tomography. 10 Many specialty surgeons also work and train in an angiography suite; currently, 50% to 75% of all vascular interventions require radiation. 11 IMPORTANCE Higher rates of infertility and pregnancy complications have been found for female surgeons compared with the general population. Several reproductive hazards are present in the operating room and may be associated with these findings. Hazards should be identified and controlled to minimize risks.OBSERVATIONS Studies comparing surgeons with the general population show increased rates of infertility and pregnancy complications, including conditions affecting both mother and fetus, such as spontaneous abortion, preterm delivery, growth restriction, and congenital abnormalities. Attention has focused on older age and demanding working conditions of pregnant surgeons; however, there are reproductive hazards present in the operating room that might also be contributing. Relevant hazards include radiation, surgical smoke, working conditions, sharps injury, anesthetic gases, and intraope...

Occupational risk perceived by pregnant workers: proposal for an assessment tool for health professionals

“…A meta-analysis investigated the exposure of nurses to anesthetic gases in operating rooms and showed a significant risk of miscarriage. 11 Anderson and Goldman 12 published a review that demonstrated the occurrence of numerous occupational risks in a surgical center that can influence adverse pregnancy outcomes and increase the infertility rate. According to Haffner et al, 13 the results of most studies of pregnant women in contact with formaldehyde suggest that, by avoiding contact during pregnancy, there may be a reduction in the relative risk of low birth weight, miscarriage, and malformations.…”

The case for compulsory surgical smoke evacuation systems in the operating theatre

“…Similarly, as noted earlier, there are hazardous substances in surgical smoke that are known to be potentially carcinogenic, mutagenic and teratogenic and there is emerging evidence that surgical smoke could also be contributing to adverse pregnancy outcomes and increased rates of infertility in female surgeons. 38 Ultimately, there is an absence of definitive evidence and in this case must be inferred from animal studies and its effects in other contexts. Nevertheless, it remains plausible that chronic exposure to surgical smoke that is not evacuated at the operative site could contribute to female infertility and pregnancy complications.…”

Electrocautery, Diathermy, and Surgical Energy Devices

“… 22 Surgical masks, even if correctly worn, can only efficiently filter out particles greater than 5 μm in size, thus making filtration of ultrafine particles, including viral particulate, difficult. 23 – 25 …”