August 9, 2023
But as a future orthopaedic surgeon, I find it impossible to ignore the inordinate amount of surgical waste and energy use related to the work we do without questioning how our actions affect the health of those we intend to heal.
The healthcare sector is responsible for 8.5% of all US greenhouse gas emissions.1 According to an article published in the December 2020 issue of Health Affairs, “…health damages stemming from US healthcare pollution [are] on the same order of magnitude as deaths from preventable medical errors.”2
Operating rooms (ORs) are particularly culpable because they generate approximately 20% to 30% of hospital waste and two-thirds of hospitals’ regulated medical waste while consuming three to six times more energy than anywhere else in the hospital.3 An increase in disposable and single-use products has exacerbated waste in the OR despite having no proven advantage in cost, sterility, or patient outcomes.4,5
Anesthesia-related waste alone represents 25% of all OR waste, despite approximately 60% of this waste being recyclable.6 Anesthetic gas emissions have significant negative environmental impact. Analysis of the life-cycle emissions of inhaled anesthetics demonstrates considerable, and often uncalculated, greenhouse gas emissions.7
For example, using the anesthetic gas desflurane for 1 hour is equivalent to driving a gasoline-powered car approximately 198 miles.8,9 Nitrous oxide, another common anesthetic gas, is a main contributor of greenhouse gas emissions and accounts for roughly half of total emissions from inhaled anesthetics.10 And even worse, due to leaking central pipeline systems, significant amounts of nitrous oxide are lost through infrastructure leaks before clinical use; some reports note that 95% of purchased nitrous oxide is wasted.11
Surgical professionals are in the unique position to dramatically reduce the environmental impact of surgical services without compromising quality or patient safety. Aligning with healthcare’s mission to do no harm, it is imperative that we begin making decisions and implementing policies to dramatically improve the sustainability of healthcare. It is contradictory to healthcare’s healing mission to generate mountains of waste and pollution which create and exacerbate health problems.
Fortunately, there is already a widespread understanding among surgeons of the significance of waste produced by ORs and a growing willingness to change surgical workflow to help reduce waste.12,13
Surgeon leaders should support the development of creative solutions to address common sources of healthcare waste. For example, construction of new clinical buildings should consider the elimination of nitrous oxide piping in favor of using individual, portable canisters when clinically indicated.
We also should incentivize research into known and unknown data gaps within the evolving field of healthcare sustainability. Federal funding should prioritize research that supports systematic evaluation of the climate impact of various surgeries, and of medical devices and supplies throughout their entire life cycles.
Additional emphasis should be placed on research that assesses the impact of carbon on public health. Academic journals and medical societies should recognize the significance of healthcare sustainability and actively dedicate journal sections and conference sessions to discussing related topics.
Similarly, medical schools should recognize the clinical and scientific merit of published work in this field and consider such research worthy of academic advancement. Notably, institutions who publicly recognize the importance of healthcare sustainability should simultaneously encourage academic clinicians to incorporate this work into their career tracks.
A cohesive effort between funding sources, medical journals and societies, and research institutions would foster an environment poised to produce the substantial changes the healthcare sector requires. Such a collaborative effort could drive the study of the economics of healthcare sustainability, lead to more sustainable practices, and facilitate partnerships with private industry to enhance the multidisciplinary development of sustainable alternatives.
As a trainee with decades remaining in my career, I recognize the potential to recruit young clinicians motivated to address the challenges of providing state-of-the-art medical care while mitigating the damaging effects of this care on the environment.
However, if we do not develop the supportive infrastructure to create opportunities to pursue sustainability initiatives, we will lose the potential for another generation of researchers, clinicians, and educators to confront this urgent, man-made crisis.
I hope that we—as healthcare leaders—continue to understand the significance of this challenge and dramatically improve the way we deliver patient care, with particular emphasis on the following priorities:
Through a consolidated effort, we can transform the healthcare sector so that future clinicians can improve the health of others while reducing the environmental impact of surgical services. B
The thoughts and opinions expressed in this viewpoint article are solely those of Dr. White and do not necessarily reflect those of the ACS.
Dr. Carter White is an inaugural Blair and Georgia Sadler Fellow at Health Care Without Harm in Reston, VA. He is a recent graduate of the University of California (UC) Davis School of Medicine and an orthopaedic surgery resident at UC San Francisco Fresno.