Green Medicine: finding the carbon footprint in the operating room

A new carbon footprint analysis of products used in UK operating rooms shows that 68% of the impact is caused by single-use items, such as gowns, patient drapes and instrument table cloths.

What is a carbon footprint?

The carbon footprint is a parameter that is used to estimate the greenhouse gas emissions caused by a product, service, organisation, event or individual, usually expressed in tonnes of CO2 equivalent (source of definition: Wikipedia). According to the Kyoto Protocol, the greenhouse gases to be taken into account are carbon dioxide (CO2, hence the name 'carbon footprint'), methane (CH4), nitrogen monoxide (N2O), hydrofluorocarbons (HFCs), perfluorocarbons (PFCs) and sulphur hexafluoride (SF6).

This parameter can be used to determine the environmental impacts that emissions have on anthropogenic climate change, i.e. all interventions by mankind to transform the natural environment. These interventions are implemented with the aim of adapting the environment to our needs and improving our quality of life. However, they do not always have a positive impact but, on the contrary, can damage the balance of ecosystems.

The measurement of a product's carbon footprint includes the quantification of all greenhouse gas emissions throughout the product's life cycle, from the extraction of raw materials to the final disposal of the product. As you can easily guess, healthcare systems have a significant impact on the carbon footprint and can be instrumental in improving the condition of the planet.

The carbon footprint in surgical procedures

Researchers from Brighton and Sussex Medical School and the University of Warwick conducted a study to systematically assess the carbon footprint of products used in common surgical operations. The analysis was based on direct observation of operating rooms at three sites of the NHS Foundation Trust's University Hospitals in Sussex.

By applying the carbon dioxide equivalent (CO2e), the standard unit for measuring carbon footprint, to each surgical operation, the researchers showed that the surgery with the highest carbon footprint was knee arthroplasty (85.5kg CO2e). This was followed by cholecystectomy (20.3kg CO2e), carpal tunnel decompression surgery (12.0kg CO2e), hernioplasty (11.7kg CO2e) and tonsillectomy (7.5kg CO2e).

The researchers found that in the five surgical operations, few products (23%) were responsible for more than 80% of the product carbon footprint. This indicates that strategies to reduce greenhouse gas emissions associated with surgical operations should focus on the few products that cause the highest emissions, typically large disposable items (often made of plastic).

Reducing carbon footprint in operating rooms

According to scholars, reducing carbon footprints in areas where many resources are used, such as operating rooms, will be important in achieving carbon-neutral healthcare. Strategies should include eliminating or finding low-carbon alternatives for products that have the greatest impact.

According to the researchers, strategies to eliminate such items include:

The researchers also suggest that some single-use products with a high environmental impact have reusable alternatives. For example, disposable gowns, patient drapes, and surgical drapes, which were found to have a high carbon footprint in the study, could be replaced by textiles. The researchers note that there is no evidence that reusable surgical fabrics, which significantly reduce the carbon footprint, are inferior from a health perspective.

According to the researchers, eliminating single-use items or switching to reusable ones where possible, together with optimising the associated decontamination processes, and waste separation and recycling, could reduce the carbon footprint set by surgical rooms by a third. This prediction is based on reusable alternatives already on the market. Clearly, this reduction could increase if the industry and supply chains take up the challenge of sustainable innovation in surgical products.

  1. Rizan C, Lillywhite R, Reed M, Bhutta MF. The carbon footprint of products used in five common surgical operations: identifying contributing products and processes. Journal of the Royal Society of Medicine. 2023;0(0). doi:10.1177/01410768231166135