Elsevier

The Surgeon

Volume 8, Issue 2, April 2010, Pages 87-92
The Surgeon

Review
Surgical fires, a clear and present danger

https://doi.org/10.1016/j.surge.2010.01.005Get rights and content

Abstract

Background

A surgical fire is potentially devastating for a patient. Fire has been recognised as a potential complication of surgery for many years. Surgical fires continue to happen with alarming frequency. We present a review of the literature and an examination of possible solutions to this problem.

Methods

The PubMed and Medline databases from 1948 onwards were searched using the subject headings “operating rooms”, “fire”, “safety” and “safety management”. “Surgical fire” was also searched as a keyword. Relevant references from articles were obtained.

Results

Fire occurs when the three elements of the fire triad, fuel, oxidiser and ignition coincide. Surgical fires are unusual in the absence of an oxygen-enriched atmosphere. The ignition source is most commonly diathermy but lasers carry a relatively greater risk. The majority of fires occur during head and neck surgery. This is due to the presence of oxygen and the extensive use of lasers.

The risk of fire can be reduced with an awareness of the risk and good communication.

Conclusions

Surgery will always carry a risk of fire. Reducing this risk requires a concerted effort from all team members.

Introduction

Of all the potential complications of surgery, a surgical fire is perhaps the most extraordinary. That patients who entrust themselves to medical care are actually set alight when at their most vulnerable seems almost unbelievable.1 Yet it happens, with alarming frequency and potentially devastating consequences.

Exact numbers are difficult to ascertain due to the absence of a standard reporting system and confidentiality clauses in many malpractice settlements2, but it does remain a relatively rare event.3 Estimates from the USA put the incidence at anything from 204, 5 to 6506, 7, 8 surgical fires each year. This makes the problem of a similar order of magnitude to wrong site surgery, a topic that has received far more attention in recent times.9 Three instances of surgical fires were reported to the National Reporting and Learning System in the UK between 2006 and 2009 (NPSA, personal communication). A US study found 17% of anaesthetic malpractice claims related to burns from surgical fires.10

Many will be minor fires causing no harm, but it is estimated that of the surgical fires that occur in the USA each year 20–30 are disabling or disfiguring and one or two are fatal.8 Airway injuries can necessitate prolonged intensive care with its accompanying morbidity.11

We present a review of the published literature on surgical fires and an examination of possible solutions to this problem.

Section snippets

Methods

The PubMed and Medline databases were searched using the subject headings “operating rooms”, “fire”, “safety” and “safety management”. “Surgical fire” was also searched as a keyword. The date range used was from 1948 onwards. Relevant references from articles were obtained. Relevant websites were identified using the Google internet search tool. Established patient safety organisations' websites were accessed for alerts and advisories relating to surgical fires.

Results

Over 400 relevant citations were identified. Many of these were case reports of specific fires. Some of these case reports also included a review of the literature as it was at the time. Other papers were non-clinical experiments exploring the conditions required for ignition, others still were intended to provide advice to clinicians in order to prevent further fires.

Conclusions

Surgical fire will always be a risk in the operating room. The danger is highest in head and neck surgery and where lasers are used. The risk can be mitigated by separating the elements of the fire triad from each other. This requires ongoing awareness of the threat and a concerted effort from all members of the operating theatre team.

Financial support

None.

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