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Background From a precision medicine perspective, this systematic review and meta-analysis synthesizes evidence on the genotoxic effects of waste anesthetic gases (WAGs) in healthcare workers. It aims to identify robust biomarkers for individualized risk assessment and to clarify the pattern of DNA damage to inform targeted monitoring strategies. Methods We conducted a comprehensive search of four databases up to September 2025, following PRISMA 2020 guidelines. Observational studies comparing genotoxic biomarkers including comet assay parameters, micronucleus frequency and chromosomal aberrations, between WAG-exposed and non-exposed healthcare workers were included. Pooled mean differences (MD) with 95% confidence intervals (CI) were calculated using random- or fixed-effects models. Study quality was assessed using the Newcastle-Ottawa Scale. Results Thirty-three studies were included. Occupational exposure to WAGs (e.g., nitrous oxide, isoflurane, sevoflurane) was associated with significantly increased DNA damage, measured by comet assay scores (MD = 7.58, 95% CI = 5.29–9.86), tail length (MD = 4.21, 95% CI = 0.26–8.15), and %tail DNA (MD = 2.97, 95% CI = 1.24–4.70). Micronucleus frequency was also elevated in both buccal cells (MD = 0.24 per 1,000 cells, 95% CI = 0.13–0.35) and lymphocytes (MD = 3.74 per 1,000 cells, 95% CI = 3.33–4.14). In contrast, the level of total chromosomal aberrations did not show a significant increase ( P = 0.20). This differential biomarker response highlights varying sensitivity to WAG-induced genetic damage. Many studies reported exposure concentrations exceeding recommended occupational limits. Conclusion This meta-analysis confirms that WAG exposure causes subclinical genotoxic damage, with biomarker patterns suggesting early DNA strand breaks and micronuclei formation are more sensitive indicators than chromosomal aberrations. These findings underscore the need for a precision prevention approach in occupational health: implementing enhanced safety measures and considering biomonitoring programs that utilize sensitive assays for early detection and individualized risk stratification among exposed personnel. Future research should investigate genetic and environmental modifiers of susceptibility to enable truly personalized risk assessment.
Li et al. (Fri,) studied this question.