Medical group to issue guidelines aimed at preventing surgery fires

Flames engulfed Kathleen Osberger's face as she lay sedated on a Chicago operating room table during what was supposed to be a simple procedure to remove two moles from her face.

Now, seven years and 18 corrective surgeries later, the 54-year-old clinical social worker is still on disability leave because of the severe burns to her upper lip, nose and nasal passages.

She says doctors have never told her what they think went wrong, but she believes oxygen collected under the surgical drapes and fed a fire sparked by surgical tools. She sued and settled with the hospital, which denied negligence.

"I believe they walked into the operating room trying to help me. However, something massively went wrong," she said.

Surgery fires are rare but serious enough that this fall the American Society of Anesthesiologists plans to issue its first guidelines aimed at preventing them. Health officials aren't required to report surgery fires, but the medical group believes they've increased over the past two decades with the use of lasers and tools that use electric current.

"We think there is a lot of underreporting and a lot of near misses," said Dr. Jan Ehrenwerth, a professor at the Yale University School of Medicine and a member of the society's task force on the issue.

ECRI Institute, a not-for-profit health research agency, estimates that there are 50 to 100 fires out of the more than 50 million surgeries performed in the United States each year. Such fires kill one to two people annually, and 20 percent of patients suffer serious, disfiguring injuries, according to ECRI, which investigates medical procedures and devices.

Most fires are caused when oxygen builds up under surgical drapes during the use of electric surgical tools that cut or remove tissue or control bleeding, the institute says.

ECRI's Mark Bruley said too many anesthesiologists are using 100 percent oxygen instead of only what the patient needs.

The proposed guidelines include lowering the concentration of oxygen given to patients during surgery by diluting it with room air when surgical tools that could ignite a fire are in use. Other suggestions are to reconfigure drapes to minimize oxygen buildup and use suction devices to remove excess oxygen from surgery sites.

Ehrenwerth disputes suggestions that anesthesiologists are unnecessarily giving high concentrations of oxygen.

"We have to look at the patient and see what's safe for the patient," he said. "We don't want them to have decreased oxygen to their heart or their brain."

Dr. Richard Greco, a plastic surgeon in Savannah, Ga., had a patient catch fire in 1991. While cauterizing an area during an eyelid procedure, excess oxygen fueled flames that burned his patient's nose.

"I was absolutely astonished that the fire occurred while I was doing everything I was trained to do," he said. "There was obviously a flaw in the system. People weren't considering the risk of fire."

He said patients can be kept stable with an oxygen levels of 30 or 40 percent during the use of electrosurgery tools.

Medical researchers and doctors say concern about surgery fires waned in the 1970s when safer anesthetics replaced ether and other flammable agents used to sedate patients. Today more electrosurgery devices are used and cloth drapes have been replaced with paper drapes, which are more flammable.

Osberger, who lives in Chicago, settled a malpractice lawsuit in 2003 against Weiss Memorial Hospital for $6 million. She's had to wear special masks, had stents inserted into her nasal passages and still has trouble breathing or smiling.

The hospital said in a statement Thursday that it has changed its procedures and follows the recommendations of a hospital accrediting group to prevent surgical fires. Those changes include how patients are prepped before surgery and how oxygen is administered. The surgical staff is also trained to prevent fires and how to respond to them, the hospital said.

Osberger believes one of the ways to decrease surgery fires is to require mandatory reporting of them.

"With the high level of skill you have in the operating room, this is preventable," she said.