In modern operating rooms, the use of heat-generating instruments for cutting, dissection, and hemostasis is standard practice. However, these tools produce a hazardous byproduct known as surgical smoke, which poses significant health risks to everyone in the surgical environment. Surgical smoke is a vaporous plume created when tissue is thermally destroyed, causing cell walls to burst and release their contents into the air. While it is composed of 95% water, the remaining 5% contains a dangerous mix of cellular debris, chemicals, blood particles, viruses, and bacteria. This aerosol spreads rapidly and can contain harmful components like carbon monoxide and polycyclic aromatic hydrocarbons, which are known to trigger genetic mutations and cancer.
The U.S. Occupational Safety and Health Administration (OSHA) estimates that over 500,000 healthcare workers are exposed to surgical smoke annually. Compounding the problem, standard surgical masks are often inadequate for filtering the ultrafine particles found in this smoke, offering incomplete protection to the surgical team. Recognizing the growing concern around this occupational hazard, a recent study by Burçak Şahin Köze, Meryem Yavuz Van Giersbergen, and Esra Özkan provides a comprehensive overview of the research landscape on this topic. Titled “Bibliometric Analysis of Studies on Surgical Smoke,” this review uses quantitative methods to map the scientific literature, offering critical insights for healthcare professionals, especially perioperative nurses, and guiding future research efforts.
Study Purpose and Methodology: Mapping the Scientific Landscape
The primary goal of this study was to examine the existing body of research on surgical smoke using bibliometric analysis and science mapping methods. Bibliometrics is a powerful analytical technique that employs mathematical and statistical tools to measure relationships and influences within published literature. By analyzing metrics like publication years, keywords, citation counts, author collaborations, and country of origin, researchers can create a detailed “map” of a scientific field, identifying key trends, influential works, and research gaps.
To conduct their analysis, the authors meticulously searched the SCOPUS database on December 25, 2023, using a specific set of keywords: “surgical smoke,” “operating room,” “operating room staff,” and “nurse”. This targeted search yielded a total of 51 relevant publications, consisting of 49 research articles and 2 reviews, published between 2001 and 2023. The data was then processed using Microsoft Excel for frequency distributions and VOSviewer software to create visual network maps of keywords and collaborations. The study aimed to answer several key questions, including trends in publication volume, leading journals, popular keywords, top contributing countries, and the most influential publications in the field.
Key Findings: A Snapshot of Surgical Smoke Research
The analysis revealed several important trends and characteristics of the research on surgical smoke:
- Peak Publication Year: The highest number of publications on surgical smoke occurred in 2021, with 11 articles, making up 21.5% of the total sample. The authors suggest this surge in interest may be linked to increased awareness of respiratory transmission risks and safety measures prompted by the COVID-19 pandemic. The study also forecasts a steady output of around 6-7 articles per year from 2024 to 2028.
- Leading Journals and Keywords: Two journals emerged as the primary outlets for this research: the Journal of Perioperative Nursing and the AORN Journal, each publishing three articles (5.9% of the total). Unsurprisingly, “surgical smoke” was the most common keyword, frequently appearing alongside terms like “surgeon” and “attitude,” highlighting the focus on professional awareness and practices. Keyword mapping is valuable because it helps researchers quickly identify core topics and their interconnections within the literature.
- Global Research Contributions: The United States is the leading country in surgical smoke research, contributing 25.4% of the publications. It is followed by China (11.7%), Iran (9.8%), Turkey (7.8%), and Thailand (5.8%). In terms of language, an overwhelming 92% of the studies were published in English, reflecting its status as the international language of science.
- Most Influential Work: The study identified the most cited publications to gauge their impact on the field. The 2003 article by Barrett and Garber titled “Surgical smoke: a review of the literature. Is this just a lot of hot air?” was the most influential, with 250 citations. Its high citation count is attributed to its comprehensive literature review, which established it as a foundational resource for subsequent research.
Implications for Perioperative Nursing and Future Research
This bibliometric analysis is not just an academic exercise; it carries significant practical implications, particularly for perioperative nurses. As vital members of the surgical team, nurses can use the insights from this study to advocate for and implement enhanced safety measures. The findings emphasize the need for heightened awareness of the hazards associated with surgical smoke and the importance of aligning clinical practice with the latest research on protective strategies.
The study also serves as a roadmap for future investigations. The authors highlight several key limitations of their own work, such as the reliance on a single database (SCOPUS) and the exclusion of non-English publications, which may have resulted in a partial view of the global research landscape. Building on this, they offer several recommendations for future research:
- Investigate the specific long-term health effects of surgical smoke exposure on healthcare workers, especially perioperative nurses.
- Evaluate the effectiveness of current safety measures and develop new interventions to mitigate risks.
- Conduct longitudinal studies to track trends and outcomes over time.
- Foster multidisciplinary collaboration among nurses, surgeons, and occupational health experts to create a comprehensive approach to managing this hazard.
Conclusion: A Call for Continued Vigilance and Research
The study by Köze, Şahin, and Özkan provides a comprehensive and data-driven overview of the current state of research on surgical smoke. By mapping the key trends, influential publications, and dominant themes, it underscores the growing recognition of surgical smoke as a serious occupational hazard. The findings are a clear call to action for the healthcare community, particularly for perioperative nurses, to remain vigilant and proactive in implementing safety protocols. Ultimately, this analysis provides an invaluable resource that will help guide future studies, contribute to the development of better safety guidelines, and work toward creating a safer operating room environment for all.
Reference: Köze, B. Ş., Yavuz Van Giersbergen, M., & Özkan, E. (2025). Bibliometric analysis of studies on surgical smoke: Bibliometric analysis. Journal of PeriAnesthesia Nursing, 40, 718–724. https://doi.org/10.1016/j.jopan.2024.07.002