Surgical Fires in Otolaryngology: A Systematic and Narrative Review

Andrew T. Day, Erika Rivera, Janice L. Farlow, Christine G. Gourin, Brian Nussenbaum

Research output: Contribution to journalReview articlepeer-review

7 Scopus citations


Objective: To bring attention to the epidemiology, prevention, management, and consequences of surgical fires in otolaryngology by reviewing the literature. Data Sources: PubMed, EMBASE, Web of Science, and Scopus. Review Methods: Comprehensive search terms were developed, and searches were performed from data source inception through August 2016. A total of 4506 articles were identified; 2351 duplicates were removed; and 2155 titles and abstracts were independently reviewed. Reference review was also performed. Eligible manuscripts described surgical fires involving patients undergoing otolaryngologic procedures. Results: Seventy-two articles describing 87 otolaryngologic surgical fire cases were identified. These occurred during oral cavity or oropharyngeal procedures (11%), endoscopic laryngotracheal procedures (25%), tracheostomies (36%), “other” general anesthesia procedures (3%), and monitored anesthesia care or local procedures (24%). Oxidizing agents consisted of oxygen alone (n = 63 of 81, 78%), oxygen and nitric oxide (n = 17 of 81, 21%), and room air (n = 1 of 81, 1%). The fractional inspired oxygen delivered was >30% in 97% of surgical fires in non–nitrous oxide general anesthesia cases (n = 35 of 36). Laser-safe tubes were used in only 12% of endoscopic laryngotracheal cases with endotracheal tube descriptions (n = 2 of 17). Eighty-six percent of patients experienced acute complications (n = 76 of 87), including 1 intraoperative death, and 22% of patients (n = 17 of 77) experienced long-term complications. Conclusion: Surgical fires in otolaryngology persist despite aggressive multi-institutional efforts to curb their incidence. Guideline recommendations to minimize the concentration of delivered oxygen and use laser-safe tubes when indicated were not observed in many cases. Improved institutional fire safety practices are needed nationally and internationally.

Original languageEnglish (US)
Pages (from-to)598-616
Number of pages19
JournalOtolaryngology - Head and Neck Surgery (United States)
Issue number4
StatePublished - Apr 1 2018


  • fire
  • fires
  • head and neck surgery
  • operating room
  • otolaryngology
  • surgical

ASJC Scopus subject areas

  • Surgery
  • Otorhinolaryngology


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