UCSF

BACKGROUND: In the United States, over 500,000 perioperative team members are exposed to surgical smoke annually. Surgical smoke, a by-product of electrocautery use during operative procedures, contains particulate matter and volatile organic compounds, which are known irritants and carcinogens with mutagenic potential. Surgical smoke adversely impacts the respiratory, cardiovascular, and neurological systems. Despite the exposure to surgical smoke in the operating room, little is known about the experience of surgical smoke by perioperative team members.PURPOSE: Past research has an almost exclusively quantitative approach, with scarce conceptual development beyond descriptions of the smoke’s content, mechanism, hazards, and mitigation strategies. The purpose of this dissertation is to use a mixed methods approach to advance the understanding of the experience of surgical smoke.METHODS: A scoping review with the aims to synthesize the evidence on how perioperative teams experience surgical smoke in operating rooms. Further, a convergent parallel mixed methods design was used to collect qualitative and quantitative data in parallel, analyze both strands separately, and then merge the results. Qualitative data consisted of semi-structured interviews with 35 multi-disciplinary perioperative team members. Verbatim transcripts were analyzed using constructivist grounded theory methods, including initial and focused coding, and memo-writing. The quantitative data consisted of participants (N=35) responses to a 22-question validated and modified Air Quality Perception scale and demographics survey. These data were analyzed using descriptive statistics and statistical testing.RESULTS: There were nine qualitative articles describing the experience of surgical smoke using various conceptually related terminology. The qualitative findings of perioperative team members described multifaceted perspectives on surgical smoke, which were termed their “stance” on the experience of surgical smoke. Each perioperative team member’s stance was their way of seeing and thinking about surgical smoke. Stance consisted of 8 dimensions. The quantitative findings revealed that most perioperative team members do not perceive exposure to surgical smoke in terms of poor air quality. The merged findings examined convergence and divergence of the qualitative and quantitative results. Four dimensions of stance were convergent, four were divergent. The convergent dimensions were Awareness, Symptoms, Meaning, and Behavioral Responses. The four divergent dimensions were Knowledge and Beliefs, Personal Impressions, Team Dynamics, and Past Experience.CONCLUSIONS: This mixed methods dissertation research offers a novel understanding of how perioperative team members experience surgical smoke. The mixed methods findings are compelling, confirming that the experience of surgical smoke is a broader and deeper phenomenon than previously understood. Understanding stance allows for targeted education and informs policy development and implementation to ensure that the hazardous exposure to surgical smoke continues to be mitigated. Describing and measuring the experience of surgical smoke has constructed the conceptual framework of stance and suggested further modification of the Air Quality Perception scale that may be transferred to other environmental settings and hazards.