D163. Making Plastic Surgery Smoke-Free: A Cost-Effectiveness Analysis

PURPOSE: Plastic surgeons may be at disproportionate risk from surgical smoke given the large, surface-level procedures inherent to this field. Thus, plastic surgery represents a salient case study of surgical smoke and safety practices. This study investigated surgical smoke exposure across common plastic surgery procedures as well as the cost-efficacy of various interventions for smoke evacuation. In addition, this study surveyed plastic surgeons regarding the relative utility of smoke evacuation practices. METHODS: This is an IRB-approved investigation of surgical smoke during three procedures (abdominoplasty/panniculectomy, breast reduction, breast reconstruction with abdominal flap). Surgical smoke exposure was measured using exhaled carbon monoxide (CO) and acetaldehyde before and after cases. Interventions included manual suction and suction bovie. RESULTS: Adjusting for participant history, there was a significant increase in exhaled CO and acetaldehyde following all three procedures (p=0.02 and 0.001, respectively), with a mean time of 2.5 hours prior to normalization of measured exhalants. Focused evacuation with manual suction most effectively limited the rise of CO/acetaldehyde levels (p=0.001), followed by suction bovie (p=0.03). Use of a suction bovie required an additional $450 for a mean reduction of 8ppm in exhaled CO per case. Incorporating smoke evacuation in the surgical timeout significantly increased intraoperative compliance (p=0.01). CONCLUSION: Surgical smoke during common plastic surgery procedures results in significant increases in exhaled carbon monoxide and acetaldehyde, comparable to literature values of light smokers. In light of legislative efforts to mitigate surgical smoke, this study can help guide plastic surgeons regarding cost-effective surgical smoke evacuation practices.