Operating rooms are among the most resource-intensive areas of a hospital, generating large amounts of waste while consuming substantial energy. Consequently, surgeons and surgical teams are uniquely positioned to reduce that environmental footprint, and such efforts can improve efficiency and lower costs.
At yesterday’s Panel Session, “Sustainability in the Operating Room,” surgeon experts highlighted practical ways surgical teams can reduce their environmental impact and described the ACS’s growing role in advancing sustainable surgical practices.
The environmental impact extends throughout surgical care, from the manufacture and transportation of supplies to energy use, anesthetic gases, instrument processing, and waste disposal.
Depending on the operation, a single case can generate substantial quantities of waste, particularly in procedures requiring multiple instrument trays or disposable supplies. Reducing that footprint can carry financial benefits, in addition to environmental gains.
“If you do save any cost on the process of improving your sustainability, you save that money and you can align it to other opportunities in your health system,” said Craig Reickert, MD, MBA, FACS, FASCRS, from Henry Ford Health in Detroit, Michigan. “You’re not just paying yourself forward. It’s a great business model.”
Dr. Reickert noted that potential interventions range from reducing unnecessary supplies and appropriately segregating regulated medical waste to optimizing HVAC systems and reconsidering what needs to be included on surgical trays. These approaches also are reflected in the ACS “Statement on the Importance of Sustainable Surgical Practices.”
Turning Commitment into Action
Elizabeth Yates, MD, MPH, from the University of Virginia in Charlottesville, explained that after helping to develop the ACS statement, participating surgeons wanted to build on it.
“After the statement was released, a lot of the cohort who worked on that effort turned around, looked at each other, and said, ‘What’s next? How do we keep this momentum going? How do we translate this into meaningful actual action?’” Dr. Yates said. “And what we came up with was ACS SUSTAIN.”
The collaborative brings together surgeons and other members of the surgical care team to share experiences and implement practical projects. The initiative is based on the premise that environmental sustainability can support surgical quality without sacrificing patient safety or clinical outcomes.
“We recognize that the top priority of a surgeon is excellent surgical outcomes and safety of our team,” Dr. Yates said. “We know firsthand that environmental sustainability initiatives cannot conflict with these goals. We’ve come to find that, in fact, they don’t. They can work synergistically.”
SUSTAIN therefore emphasizes interventions that can be incorporated into existing workflows and adapted to different practice environments.
“We designed SUSTAIN in an effort to be a collaborative where surgeons, anesthesiologists, OR nurses, and administrators can come together to implement practical ideas and initiatives in the OR to improve their own sustainability,” Dr. Yates said.
Updating Preference Cards Reduces Waste and Costs
One of SUSTAIN’s first major efforts is a national Preference Card Optimization Campaign, designed to help surgical teams reduce supplies routinely opened but not used during procedures. The campaign also demonstrates how sustainability and financial stewardship can reinforce each other.
Colleen M. Fitzpatrick, MD, FACS, from Cohen Children’s Medical Center in Hillside Manor, New York, described reviewing her own preference card and identifying supplies that could be moved from routinely opened items to those kept available only when needed. While the environmental impact of removing an individual item may be difficult to calculate, its cost provides another way to demonstrate value.
“I would love to be having this conversation not in dollars and cents, but in tons of CO2 removed from the atmosphere,” she said. “But I can talk dollars and cents, which is the language the front office understands. And I think we in the room all know that those dollars and cents represent decreased emissions from decreased production, decreased packaging, and decreased transportation.”
A Broader View of Sustainable Surgery
Beyond individual supplies and preference cards lies the “triple bottom line,” which considers people, the planet, and financial performance together.
“The OR is healthcare’s hot spot,” said Neelima Tummala, MD, FACS. “It’s a small area with a huge impact.”
Surgical teams can intervene at numerous points along the perioperative pathway, including patient selection and preoperative optimization, virtual consultations when appropriate, reusable or reprocessed devices, streamlined instrument trays, lower-impact anesthetic gases, HVAC setbacks during nonoperative hours, and appropriate waste segregation.
The stakes extend beyond hospital operations because healthcare itself is a substantial contributor to the environmental conditions that increasingly affect patients. Dr. Tummala noted that the US healthcare sector accounts for an estimated 8% to 10% of the nation’s greenhouse gas emissions.
Dr. Tummala emphasized that reducing those emissions does not require compromising surgical outcomes.
“Quality does not have to suffer just because we lower our greenhouse gas emissions,” she said, citing data from countries such as France and Japan that achieve comparable patient outcomes with a lower environmental impact than the US.
The session is available for viewing on the conference Meeting Platform for all registrants.
