Empowering Surgeons, Anesthesiologists, and Obstetricians to Incorporate Environmental Sustainability in the Operating Room

Abstract

Objective:We review the existing research on environmentally sustainable surgical practices to enable SAO to advocate for improved environmental sustainability in operating rooms across the country.Summary of Background Data:Climate change refers to the impact of greenhouse gases emitted as a byproduct of human activities, trapped within our atmosphere and resulting in hotter and more variable climate patterns.1 As of 2013, the US healthcare industry was responsible for 9.8% of the country's emissions2; if it were itself a nation, US healthcare would rank 13th globally in emissions.3 As one of the most energy-intensive and wasteful areas of the hospital, ORs drive this trend. ORs are 3 to 6 times more energy intensive than clinical wards.4 Further, ORs and labor/delivery suites produce 50%–70% of waste across the hospital.5,6 Due to the adverse health impacts of climate change, the Lancet Climate Change Commission (2009) declared climate change “the biggest global health threat of the 21st century” and predicted it would exacerbate existing health disparities for minority groups, children and low socioeconomic patients.7Methods/Results:We provide a comprehensive narrative review of published efforts to improve environmental sustainability in the OR while simultaneously achieving cost-savings, and highlight resources for clinicians interested in pursuing this work.Conclusion:Climate change adversely impacts patient health, and disproportionately impacts the most vulnerable patients. SAO contribute to the problem through their resource-intensive work in the OR and are uniquely positioned to lead efforts to improve the environmental sustainability of the OR.

Building sustainable and resilient surgical systems: A narrative review of opportunities to integrate climate change into national surgical planning in the Western Pacific region

“… 45 Environmentally preferable purchasing policies should be developed to guide sustainable procurement decisions. 119 , 120 …”

Prescriptions for Mitigating Climate Change–Related Externalities in Cancer Care: A Surgeon's Perspective

“…49 Current recommendations are to leverage low fresh gas flow rates and a combination of intravenous anesthetics and inhaled agents (balanced technique) to reduce the overall amounts of volatile gases needed. 6,49 In conclusion, in many respects, climate-sensitive practices can be viewed as health-promoting practices in light of the negative impact of the current climate crisis on health care outcomes. The surgical oncology community has a vested interest in building resiliency against climate change, and we hope that the present article will help galvanize surgical oncologists to become more attentive to the adoption of such actions in their own practices and more forceful advocates for climate resiliency to policymakers, hospital administrators, peers, and the lay public.…”

The Triple Bottom Line and Stabilization Wedges: A Framework for Perioperative Sustainability

“…20 Propofol is a commonly used intravenous anesthetic, and it is often preferred over inhaled anesthesia to reduce the risk of postoperative nausea and vomiting after surgery. 26,27 However, propofol is also associated with a high volume of OR waste. The drug accounts for approximately 45% of all drugs disposed, and 33% to 50% of the drug is drawn up and subsequently discarded without being administered to patients.…”

“…52,53 One way to curb both packaging waste and the number of unused instruments is to adopt a “just in time” approach, where potentially necessary instruments remain unopened at the beginning of a case but are readily unpackaged for use when needed. 26,51 Updating surgeon preference cards and providing cost feedback to surgeons on surgical supply costs are additional ways to raise awareness about OR waste from preemptively opening supplies that will not be used during the actual procedure. 52,53…”

“…Maintaining a dialogue between manufacturers, institutional purchasers, and perioperative clinicians can help cultivate ideas on reducing GHG emissions without reducing clinical efficacy. 26…”