Long-Term OR Employment Linked to COPD in Female Nurses

Investigators found that exposure to surgical smoke and disinfectants over a long period of time led to increased risk of COPD in US female nurses.

A recent, large cohort study on the health and safety of US female nurses found that operating room employment of 15 years or more was associated with an increased risk of developing chronic obstructive pulmonary disease (COPD).

Investigators led by Orianne Dumas, PhD, French Institute of Health and Medical Research, reported that employment in operating rooms was potentially linked to exposure to several inhaled agents such as surgical smoke and disinfectants. These agents were associated with adverse respiratory health effects.

Though these associations exist, little was known on the association of long-term employment in operating rooms and chronic obstructive pulmonary disease.

Utilizing data from the Nurses’ Health Study (NHS). Dumas and colleagues conducted a large prospective study of US female nurses and assessed the association through the duration of operating room nursing and job type to proxy potential exposure to disinfectants and surgical smoke.

The team hypothesized that burses with any history in an operating room would be more likely to develop the disease than those with no operating room history.

The Methods

A total of 75, 011 female nurses were included in the analysis, 29% of whom had a history of employment within the operating room. Of the total number of participants, 3% had 15 or more years of operating room experience.

The data used for the study came from questionnaires that were issued and submitted in 1982 and 1984, and analyses of the data were conducted from April 1, 2020, to January 31, 2021.

Additionally, operating room employment history was evaluated in 1984, and was defined as the baseline for the study. Questionnaire-based data continued to be collected biennially thereafter.

In 1982, participating nurses reported their current employment status (nursing education, outpatient care or community nursing, inpatient staff nursing, operating room nursing, etc.), and in 1984 for the total number of years of regular work in an OR (none, <1 year, 1-4 years, 5-9 years, 10-14 years, and 􏰢15 years).

Supplemental COPD questionnaires were issued in 1998 and 2000 to every participant who reported a physician’s diagnosis of emphysema or chronic bronchitis.

Finally, auxiliary analyses were conducted to assess the robustness of the results, and exclusions were made for patients who reported a COPD diagnosis within 4 years from baseline. Further exclusions were made based on other conditions such as cancer and diabetes.

The Findings

Dumas and colleagues found that 1091 incident events of COPD were reported between 1984 and 2000.

As they predicted, there were higher incident rates of chronic obstructive pulmonary disease associated with longer operating room employment history, with a 16% increase in developing the disease. However, the unadjusted incident rates of COPD among nurses reporting less than 5 years and 5 to 14 years of ORN employment history were similar.

Among the participants, 71% never worked in an operating room, and 3% reported 15 or more years of OR employment. Respondents with longer OR employment histories were less likely to be non-Hispanic White (≥15 y employment vs none: 2270 of 2381 [95.3%] vs 51 913 of 53 433 [97.2%]) and were more likely have obesity (≥15 y employment vs none: 333 of 2251 [14.8%] vs 6697 of 50 788 [13.2%]).

Additionally, when compared with working in administration, nursing education, or a non-nursing job, employment in an outpatient or community nurse setting was associated with a higher incidence of COPD.

Due to the lack of data on the subject prior to the study, investigators believed further research was warranted to establish a stronger association between occupational exposure and the risk of COPD in nurses.

“Additional studies with more recent and direct environmental monitoring data of multiple occupational exposures appear to be needed to examine the contributions of exposure to surgical smoke and disinfectants to the risk of developing COPD,” the team wrote.

The study, "Association of Occupational Exposure to Inhaled Agents in Operating Rooms With Incidence of Chronic Obstructive Pulmonary Disease
Among US Female Nurses,"
was published online in JAMA Open Network.