Environmental Sustainability in Orthopaedic Surgery

Abstract

Climate change has been increasingly recognized in the healthcare sector over recent years, with global implications in infrastructure, economics, and public health. As a result, a growing field of study examines the role of healthcare in contributing to environmental sustainability. These analyses commonly focus on the environmental impact of the operating room, due to extensive energy and resource utilization in surgery. While much of this literature has arisen from other surgical specialties, several environmental sustainability studies have begun appearing in the field of orthopaedic surgery, consisting mostly of waste audits and, less frequently, more comprehensive environmental life cycle assessments. The present study aims to review this limited evidence. The results suggest that methods to reduce the environmental impact of the operating room include proper selection of anesthetic techniques that have a smaller carbon footprint, minimization of single use instruments, use of minimalist custom-design surgical packs, proper separation of waste, and continuation or implementation of recycling protocols. Future directions of research include higher-level studies, such as comprehensive life cycle assessments, to identify more opportunities to decrease the environmental impact of orthopaedic surgery. Climate change and environmental sustainability are topics of increasing importance and visibility in the public eye. Their presence in health care are growing but still nascent. 1 Health care is one of the largest sectors in the United States, and surgery is a particularly resourceintensive field within medicine. 2 In orthopaedic surgery, limited high-level evidence exists to guide best practices in reducing the field's environmental impact and associated carbon emissions. This review first provides context for the current state of climate change and environmental sustainability. Next, evidence is reviewed regarding environmental sustainability within the overall healthcare system, the operating room in particular, and finally orthopaedic surgery. A final discussion centers on the possible future directions for research into how the field of orthopaedic surgery may decrease

The environmental impact of health care for musculoskeletal conditions: A scoping review

“…There were 21 editorials with authors from 13 countries; Australia [ 107 – 111 ], Brazil [ 109 ], Canada [ 112 ], Germany [ 109 ], Greece [ 109 ], India [ 113 , 114 ], New Zealand [ 109 , 115 ], Norway [ 109 , 111 , 114 , 116 ], Pakistan [ 109 ], Sweden [ 109 , 117 , 118 ], Switzerland [ 109 , 119 ], United Kingdom [ 100 , 109 , 117 , 120 – 122 ] and United States [ 109 , 116 , 123 – 127 ]. There were four narrative reviews, two from the United States [ 128 , 129 ] and one each from India [ 130 ] and the United Kingdom [ 131 ]. Thirty-six (73%) included publications were related to orthopaedic surgery [ 83 – 104 , 106 , 117 , 120 – 131 ].…”

“…One narrative review on environmental sustainability in orthopaedic surgery, that identified all seven relevant studies that we included, highlighted a need for high-quality research on best practices for orthopaedic surgery to reduce its carbon footprint [ 129 ] (see Table 1 ). The remaining narrative review explored bioresorbable orthopaedic implants as a sustainable alternative to traditional permanent implants for some orthopaedic surgeries [ 130 ].…”

The Hybridge Technique: A Combined Technique of Suture Bridge and Tension Band for an Arthroscopic Eco-Responsible Rotator Cuff Repair

“… 12 , 13 The main areas of improvement are the reduction of waste volumes and in the equipment supply chain. 14 , 15 , 16 Surgeons play a primary role in reducing the surgical carbon footprint. 12 , 17 Reducing the number of anchors used during surgery is simple and innovative as well as eco-responsible.…”

Reducing the Environmental Impact of the OR

“…5 Global warming decreases food and water supplies, increases the risk of infectious disease, and contributes to economic disruption. 8 In fact, more than 5 million deaths annually can be attributed to nonoptimal temperatures resulting from climate change. 8,9 Air pollution, heat waves, and wildfires can exacerbate cardiovascular disease, asthma, allergies, and infectious disease transmissibility; and the continued increase in the number and severity of weather events creates a greater demand for trauma and mental health care and disrupts access to surgical care.…”

“…8 In fact, more than 5 million deaths annually can be attributed to nonoptimal temperatures resulting from climate change. 8,9 Air pollution, heat waves, and wildfires can exacerbate cardiovascular disease, asthma, allergies, and infectious disease transmissibility; and the continued increase in the number and severity of weather events creates a greater demand for trauma and mental health care and disrupts access to surgical care. 5 Bonnie Weinberg, MSN, RN, CNOR, clinical practice specialist, The Valley Hospital, Ridgewood, NJ, indicated that it is essential for perioperative team members to have an interest in saving the planet.…”