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Review
January 2, 2020

Occupational Reproductive Hazards for Female Surgeons in the Operating Room: A Review

Author Affiliations
  • 1Western Health Surgical Department, Victoria, Australia
  • 2Harvard T. H. Chan School of Public Health, Boston, Massachusetts
  • 3Department of Medicine, Harvard Medical School, Boston, Massachusetts
  • 4Department of Environmental Health, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
  • 5Cambridge Health Alliance, Department of Medicine, Cambridge, Massachusetts
JAMA Surg. Published online January 2, 2020. doi:10.1001/jamasurg.2019.5420
Abstract

Importance  Higher rates of infertility and pregnancy complications have been found for female surgeons compared with the general population. Several reproductive hazards are present in the operating room and may be associated with these findings. Hazards should be identified and controlled to minimize risks.

Observations  Studies comparing surgeons with the general population show increased rates of infertility and pregnancy complications, including conditions affecting both mother and fetus, such as spontaneous abortion, preterm delivery, growth restriction, and congenital abnormalities. Attention has focused on older age and demanding working conditions of pregnant surgeons; however, there are reproductive hazards present in the operating room that might also be contributing. Relevant hazards include radiation, surgical smoke, working conditions, sharps injury, anesthetic gases, and intraoperative use of toxic agents. Published evidence is limited to retrospective studies. Robust data are often unavailable to guide specific dose-response relationships, making it difficult to quantify risk and create occupational safety guidelines. Nevertheless, regulatory agencies have set exposure limits for some agents, relying on limited evidence. Various workplace interventions have shown success in reducing exposure levels for many reproductive hazards and should be adopted by surgical workplaces.

Conclusions and Relevance  Reproductive hazards exist in the operating room that may contribute to pregnancy complications and infertility in surgeons. Information and guidance should be given to female surgeons and trainees of reproductive age, and efforts should be made in the workplace to control exposures but not restrict female surgeons’ activities unnecessarily.

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