Efforts to Make ORs More Environmentally Friendly
Reducing and reversing climate change is arguably the largest problem of modern times. Efforts to gain support and make changes are continuing to gather traction. For example, during the Leaders’ Summit on Climate in April 2021, President Joe Biden announced his goal to drastically reduce the United States’ greenhouse gas emissions by 2030. However, it is not only the energy, manufacturing, and agriculture sectors that need to address their environmental impacts. What is the role of the medical community, which accounts for nearly 9% of American greenhouse gas emissions, in these climate change reduction efforts? In the context of operating rooms (ORs), a significant source of medical greenhouse gases, there have been persistent efforts to make them more environmentally friendly 1.
An important paper from 2022 outlines how surgery, particularly cancer surgery, contributes to climate change. Indeed, surgery plays a disproportionate role in the carbon output and the waste we produce in medicine. Operating rooms are a significant source of greenhouse gas production for hospitals, representing 70% of their waste and generating 3 to 6 times more carbon than the rest of health systems. A robotic-assisted hysterectomy, for example, produces as much carbon as driving more than 2,200 miles in a car 1. In light of this, the study authors suggested several solutions to fight the problem, from reducing waste to rethinking the delivery of surgical care; specifically, intense levels of care provided over a short period of time, such as cancer care and various minimally invasive surgeries, are particularly ripe for strategic improvement.
One of the easiest changes to implement in ORs to make them more environmentally friendly is linked to waste reduction. This could include making sure that anything thrown away before or during surgery is properly categorized and labeled. Some data show that over 90% of OR waste does not meet the necessary standards for the type of trash it ends up in. In addition, hospitals could consider switching to reusable or reprocessed devices and surgical gowns. Appropriate safeguards can ensure that reusing or reprocessing equipment does not increase the risk of contamination or infection. Finally, the surgical supply chain could be made more efficient as well. Moving more manufacturing of surgical supplies closer to hospitals or sourcing from local suppliers could further make ORs more environmentally friendly.
Another powerful way to reduce the environmental footprint of healthcare is to change how surgical care is delivered. This can include permanently offering telemedical consultations, as well as reducing low-value care which is often associated with unnecessary testing, scans, and procedures.
Several inhaled gases regularly used for anesthesia contribute heavily to greenhouse gas production. Nitrous oxide is a greenhouse gas which does not dissipate from the atmosphere for more than a century after it’s produced. The inhaled anesthetic sevoflurane, since it has much less of an environmental impact than nitrous oxide and other common inhaled agents, represents a viable alternative. In the end, the larger goal is to shift away from some of these greenhouse gases 1.
In line with these efforts, for example, the University of Pittsburgh Medical Center (UPMC) will phase out the use of the anesthetic desflurane across the 40-hospital system by the end of 2023 2. Desflurane, a general anesthetic gas commonly used to help patients achieve a deep level of sedation in the OR, is a strong greenhouse gas which harms the ozone layer. Alternatives to desflurane that are safe, effective, and more environmentally friendly include both intravenously delivered medications and various other inhaled gases. 2.
References
1. Operating rooms are the climate change contributor no one’s talking about. Available at: https://ihpi.umich.edu/news/operating-rooms-are-climate-change-contributor-no-ones-talking-about. (Accessed: 5th December 2023)
2. UPMC to Cease Use of Environmentally Harmful Anesthetic by End of 2023 – UPMC & Pitt Health Sciences News Blog. Available at: https://inside.upmc.com/upmc-to-cease-use-of-environmentally-harmful-anesthetic-by-end-of-2023/. (Accessed: 5th December 2023)
3. Greener ORs: Keys to making the business case. Available at: https://www.ormanager.com/environmental-issues-2/.