Catching Fire: Are Operating Room Fires a Concern in Orthopedics?

Operating room (OR) fires are considered "never events," but approximately 650 events occur annually in the United States. Our aim was to detail fires occurring during orthopedic procedures via a questionnaire because of the limited information present on this topic.

A 25-question survey on witnessing surgical fires, hospital policies on surgical fires, and surgeons' perspective on OR fires was sent to 617 orthopedic surgeons in 18 institutions whose residency program is a member of the Collaborative Orthopaedic Educational Research Group. The response rate was 28%, with 172 surgeons having completed the survey.

Twelve of the 172 orthopedic surgeons surveyed reported witnessing at least 1 surgical fire in an OR setting. Electrocautery was the leading ignition source, causing fires in 7 events. A saw, laser, and light source were reported to have caused 1 fire each. Regarding fuel source for the fires, bone cement was a common culprit (n = 4), followed by gauze (n = 3). Oxygen delivery to patients was via a closed system in most cases (n = 9). No patient harm was reported in any of these cases.Just under half of the respondents (47.7%) reported not receiving any formal OR fire prevention or response training. The most common answer for frequency of concern about a surgical fire was "never" (42.4%).

Fires pose a risk in surgery, even in an orthopedics setting. Room oxygen can supply enough oxidizing power for a fire to occur, especially with the ubiquitous nature of ignition sources and fuels in the OR. Prevention is key with these events. Operating room personnel education must be sought, and surgeons should be mindful of the fire components in the OR.