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Kodumuri P, Joshi P, Malek I. Assessment of the carbon footprint of total hip arthroplasty and opportunities for emission reduction in a UK hospital setting. Bone Jt Open 2024; 5:742-748. [PMID: 39251214 PMCID: PMC11383638 DOI: 10.1302/2633-1462.59.bjo-2024-0027.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/11/2024] Open
Abstract
Aims This study aimed to assess the carbon footprint associated with total hip arthroplasty (THA) in a UK hospital setting, considering various components within the operating theatre. The primary objective was to identify actionable areas for reducing carbon emissions and promoting sustainable orthopaedic practices. Methods Using a life-cycle assessment approach, we conducted a prospective study on ten cemented and ten hybrid THA cases, evaluating carbon emissions from anaesthetic room to recovery. Scope 1 and scope 2 emissions were considered, focusing on direct emissions and energy consumption. Data included detailed assessments of consumables, waste generation, and energy use during surgeries. Results The carbon footprint of an uncemented THA was estimated at 100.02 kg CO2e, with a marginal increase to 104.89 kg CO2e for hybrid THA. Key contributors were consumables in the operating theatre (21%), waste generation (22%), and scope 2 emissions (38%). The study identified opportunities for reducing emissions, including instrument rationalization, transitioning to LED lighting, and improving waste-recycling practices. Conclusion This study sheds light on the substantial carbon footprint associated with THA. Actionable strategies for reducing emissions were identified, emphasizing the need for sustainable practices in orthopaedic surgery. The findings prompt a critical discussion on the environmental impact of single-use versus reusable items in the operating theatre, challenging traditional norms to make more environmentally responsible choices.
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Pillay L, Winkel KD, Kariotis T. Developing the green operating room: exploring barriers and opportunities to reducing operating room waste. Med J Aust 2024; 221:279-284. [PMID: 39039604 DOI: 10.5694/mja2.52394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/11/2024] [Indexed: 07/24/2024]
Abstract
The Australian health care system contributes 7% of the national greenhouse gas emission footprint and generates massive waste streams annually. Operating rooms are a particular hotspot, generating at least 20% of the total hospital waste. A systematic search of several global academic databases was conducted in mid-2022 (articles from 1992 to 2022) for peer-reviewed research relevant to waste management in the operating rooms. We then used thematic analysis to enumerate and characterise the strategies and barriers to sustainable waste management in the operating room. The waste reduction strategies focused on avoidance of high carbon products; correct waste segregation and reduced overage; reusing, reprocessing, and repurposing devices; and improved recycling. The first barrier identified was a constrained interpretation of the concept of "first do not harm", ingrained in surgeons' practices, in prioritising single-use surgical products. The second barrier was ineffective or insufficient waste education. The third barrier was the immediate cost of implementing waste management compared with the long term realisation of environmental and economic benefits. The last barrier to implementing institutional practice change was the lack of policies and regulations at the local hospital, federal and international levels. We also evaluated the knowledge gaps in current surgical waste research, including lack of benchmarking data and standardised regulations concerning reusable or reprocessed devices, as well as the methods used to promote pro-sustainability behavioural change.
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Affiliation(s)
| | - Kenneth D Winkel
- Centre for Health Policy, University of Melbourne, Melbourne, VIC
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Mohr-Sasson A, Aycock M, Higgason N, Hui M, Bhalwal A, Jalloul R, Leon MG, Dziadek O, Montealegre A. Excess use of surgical supplies in minimally invasive benign gynecology surgery: an observational study. Am J Obstet Gynecol 2024; 231:273.e1-273.e7. [PMID: 38761838 DOI: 10.1016/j.ajog.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/13/2024] [Accepted: 05/11/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND Single-use materials and equipment are regularly opened by the surgical team during procedures but left unused, potentially resulting in superfluous costs and excess environmental waste. OBJECTIVE This study aimed to estimate the excess use of surgical supplies in minimally invasive benign gynecologic surgeries. STUDY DESIGN This is a prospective observational study conducted at a university-affiliated single tertiary medical center. Designated study personnel were assigned to observe surgical procedures performed during July to September 2022. Surgical teams were observed while performing surgeries for benign indications. The teams were not informed of the purpose of the observation to avoid potential bias. Disposable materials and equipment opened during the procedure were documented. Excess supplies were defined as those opened but left unused before being discarded. Costs per item of the excess supplies were estimated on the basis of material and equipment costs provided by the hospital. RESULTS A total of 99 surgeries were observed, including laparoscopic (32%), robotic (39%), hysteroscopic (14%), vaginal (11%), and laparotomy procedures (3%). Excess use of surgical supplies was documented in all but one procedure. The total cost across all surgeries reached $6357. The contained tissue extraction bag was the most expensive item not used (Applied Medical, Rancho Santa Margarita, CA; $390 per unit) in 4 procedures, contributing 25.54% to the total cost. Raytec was the most common surgical waste, with a total of n=583 opened but unused (average n=5.95 per surgery). A significant difference was found in the rate of excess supplies across the surgical approaches, with robotic surgery contributing 52.19% of the total cost (P=.01). CONCLUSION Excess use of disposable materials and equipment is common in minimally invasive benign gynecologic surgeries and contributes to superfluous costs and excess environmental waste. It is predominantly attributed to the opening of inexpensive materials that are left unused during the procedure. Increased awareness of costs and generated waste may reduce excess use of surgical supplies and should be further explored in future research.
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Affiliation(s)
- Aya Mohr-Sasson
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Madison Aycock
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Noel Higgason
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Mason Hui
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Asha Bhalwal
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Randa Jalloul
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Mateo G Leon
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Olivia Dziadek
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
| | - Alvaro Montealegre
- Advanced Minimally Invasive Gynecologic Surgery, Department of Obstetrics, Gynecology & Reproductive Sciences, McGovern Medical School at The University of Texas Health Science Center, Houston, TX
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Nakarai H, Kwas C, Mai E, Singh N, Zhang B, Clohisy JC, Merrill RK, Pajak A, Du J, Kazarian GS, Kaidi AC, Samuel JT, Qureshi S, Cunningham ME, Lovecchio FC, Kim HJ. What Is the Carbon Footprint of Adult Spinal Deformity Surgery? J Clin Med 2024; 13:3731. [PMID: 38999297 PMCID: PMC11242213 DOI: 10.3390/jcm13133731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/05/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: While the economic cost of adult spinal deformity (ASD) surgery has been studied extensively, its environmental impact is unknown. The aim of this study is to determine the carbon footprint (CF) associated with ASD surgery. Methods: ASD patients who underwent > four levels of corrective surgery between 2017 and 2021 were included. The open group included a posterior-only, single-stage technique, while the minimally invasive surgery (MIS) group was defined as the use of lateral interbody fusion and percutaneous posterior screw fixation. The two groups were propensity-score matched to adjust for baseline demographic, surgical, and radiographic characteristics. Data on all disposables and reusable instruments, anesthetic gas, and non-gas medications used during surgery were collected from medical records. The CF of transporting, using, and disposing of each product and the footprint of energy use in operating rooms were calculated. The CF produced was evaluated using the carbon dioxide equivalent (CO2e), which is relative to the amount of CO2 with an equivalent global warming potential. Results: Of the 175 eligible patients, 15 pairs (65 ± 9 years, 47% female) were properly matched and analyzed for all variables. The average CF generated per case was 147.7 ± 37.3 kg-CO2e, of which 54% was attributable to energy used to sterilize reusable instruments, followed by anesthetic gas released into the environment (17%) and operating room air conditioning (15%). Conclusions: The CF generated during ASD surgery should be reduced using a multidisciplinary approach, taking into account that different surgical procedures have different impacts on carbon emission sources.
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Affiliation(s)
- Hiroyuki Nakarai
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
- Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Cole Kwas
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
| | - Eric Mai
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
| | - Nishtha Singh
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
| | - Bo Zhang
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
| | - John C. Clohisy
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
| | - Robert K. Merrill
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
| | - Anthony Pajak
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
| | - Jerry Du
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
| | - Gregory S. Kazarian
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
| | - Austin C. Kaidi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
| | - Justin T. Samuel
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
| | - Sheeraz Qureshi
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
| | | | - Francis C. Lovecchio
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
| | - Han Jo Kim
- Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA
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Tsay EL, Sabharwal S. Reuse of Orthopaedic Equipment: Barriers and Opportunities. JBJS Rev 2024; 12:01874474-202403000-00005. [PMID: 38466800 DOI: 10.2106/jbjs.rvw.23.00117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/13/2024]
Abstract
» Reuse of orthopaedic equipment is one of many potential ways to minimize the negative impact of used equipment on the environment, rising healthcare costs and disparities in access to surgical care.» Barriers to widespread adoption of reuse include concerns for patient safety, exposure to unknown liability risks, negative public perceptions, and logistical barriers such as limited availability of infrastructure and quality control metrics.» Some low- and middle-income countries have existing models of equipment reuse that can be adapted through reverse innovation to high-income countries such as the United States.» Further research should be conducted to examine the safety and efficacy of reusing various orthopaedic equipment, so that standardized guidelines for reuse can be established.
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Affiliation(s)
- Ellen L Tsay
- University of California, San Francisco, San Francisco, California
| | - Sanjeev Sabharwal
- University of California, San Francisco, San Francisco, California
- UCSF Benioff Children's Hospital Oakland, Oakland, California
- Institute of Global Orthopaedics and Traumatology, San Francisco, California
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