Best in Surgery| Volume 171, ISSUE 5, P1142-1147, May 2022

Surgeons’ perspectives on operating room waste: Multicenter survey

Published:January 26, 2022DOI:



      Waste is endemic in the U.S. health care system. Operating rooms are a source of significant solid waste. Surgeons are integral to many decisions in the operating room.


      Online survey of surgeons at 2 major academic centers in the United States assessing perspectives on intraoperative waste and willingness to work to actively reduce intraoperative waste.


      We received responses from 219 surgeons: 90% agreed or strongly agreed that waste of sterile surgical items is an issue, and 95% agreed or strongly agreed to a willingness to change the operating room workflow to reduce waste. Surgeons estimated 26% of single-use, sterile supplies opened for surgery were unused at the end of the case. The barriers to waste reduction cited most frequently were: (1) lack of awareness of waste, (2) lack of concern for waste, and (3) lack of time to address the waste.


      Surgeons understand there is significant waste in the operating room and are willing to change their workflow to reduce waste. Changes in operating room practices that reduce waste will be beneficial to health systems’ finances and their efforts to improve population health through a reduction in consumption and pollution. Efforts should be directed toward reducing operating room waste with an initial focus on the elimination of unnecessary waste of sterile surgical supplies. Further work is needed to determine the precise sources of perioperative waste and what initiatives can be implemented to reduce this burden while maintaining high-value patient care.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Shrank W.H.
        • Rogstad T.L.
        • Parekh N.
        Waste in the US health care system: estimated costs and potential for savings.
        JAMA. 2019; 322: 1501-1509
        • Landrigan P.J.
        • Fuller R.
        • Acosta N.J.R.
        • et al.
        The Lancet Commission on pollution and health.
        Lancet. 2018; 391: 462-512
        • Eckelman M.J.
        • Huang K.
        • Lagasse R.
        • Senay E.
        • Dubrow R.
        • Sherman J.D.
        Health care pollution and public health damage in the United States: an update.
        Health Aff (Millwood). 2020; 39: 2071-2079
        • Practice Greenhealth
        sustainability benchmark data.
        Date: 2019
        Date accessed: January 21, 2022
        Date accessed: January 21, 2022
        • Pacific Environmental Services Inc
        Medical waste incinerator waste management plan: Malcolm Grow Medical Center, Andrews Air Force Base.
        IERA-RS-BR-SR-2001-0004, Maryland2001
        • Practice Greenhealth
        Greening the OR.
        • Rosenblatt W.H.
        • Silverman D.G.
        Cost-effective use of operating room supplies based on the REMEDY database of recovered unused materials.
        J Clin Anesth. 1994; 6: 400-404
        • Meyer M.J.
        Doctors pledge to do no harm: the entire health care sector should do the same by battling climate change.
        STAT News, 2021
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        Research electronic data capture (REDCap): a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Petre M.A.
        • Bahrey L.
        • Levine M.
        • van Rensburg A.
        • Crawford M.
        • Matava C.
        A national survey on attitudes and barriers on recycling and environmental sustainability efforts among Canadian anesthesiologists: an opportunity for knowledge translation.
        Can J Anaesth. 2019; 66: 272-286
        • McGain F.
        • White S.
        • Mossenson S.
        • Kayak E.
        • Story D.
        A survey of anesthesiologists’ views of operating room recycling.
        Anesth Analg. 2012; 114: 1049-1054
        • Chang D.F.
        • Thiel C.L.
        Ophthalmic Instrument Cleaning and Sterilization Task Force. Survey of cataract surgeons’ and nurses’ attitudes toward operating room waste.
        J Cataract Refract Surg. 2020; 46: 933-940
        • UCSF Office of Sustainability
        Greening the health system.
        • UCSF Office of Sustainability
        Help UCSF reach carbon neutrality by 2025.
        • Zygourakis C.C.
        • Yoon S.
        • Valencia V.
        • et al.
        Operating room waste: disposable supply utilization in neurosurgical procedures.
        J Neurosurg. 2017; 126: 620-625
        • Schmidt B.
        • Meng M.V.
        • Hampson L.A.
        Operating room supply cost awareness: a cross-sectional analysis.
        Urol Pract. 2019; 6: 73-78
        • Zygourakis C.C.
        • Valencia V.
        • Moriates C.
        • et al.
        Association between surgeon scorecard use and operating room costs.
        JAMA Surg. 2017; 152: 284-291
        • Namburar S.
        • Pillai M.
        • Varghese G.
        • Thiel C.
        • Robin A.L.
        Waste generated during glaucoma surgery: a comparison of two global facilities.
        Am J Ophthalmol Case Rep. 2018; 12: 87-90
        • Watts N.
        • Amann M.
        • Arnell N.
        • et al.
        The 2020 report of the Lancet Countdown on health and climate change: responding to converging crises.
        Lancet. 2021; 397: 129-170
        • Atwoli L.
        • Baqui A.H.
        • Benfield T.
        • et al.
        Call for emergency action to limit global temperature increases, restore biodiversity, and protect health.
        N Engl J Med. 2021; 385: 1134-1137
        • Kaiser Permanente
        Sustainable procurement: improving health.
        • MacNeill A.J.
        • Hopf H.
        • Khanuja A.
        • et al.
        Transforming the medical device industry: road map to a circular economy.
        Health Aff (Millwood). 2020; 39: 2088-2097
        • Rose E.D.
        • Modlin D.M.
        • Ciampa M.L.
        • Mangieri C.W.
        • Faler B.J.
        • Bandera B.C.
        Evaluation of operative waste in a military medical center: analysis of operating room cost and waste during surgical cases.
        Am Surg. 2019; 85: 717-720
        • Simona R.W.
        • Canacarib E.G.
        • Gamboac K.A.
        • Giurinid J.M.
        OR waste reduction. Perioper Care Oper Room Manag. 2019; 15: 100073
        • Tabib C.H.
        • Bahler C.D.
        • Hardacker T.J.
        • Ball K.M.
        • Sundaram C.P.
        Reducing operating room costs through real-time cost information feedback: a pilot study.
        J Endourol. 2015; 29: 963-968
        • Zhao B.
        • Tyree G.A.
        • Lin T.C.
        • et al.
        Effects of a surgical receipt program on the supply costs of five general surgery procedures.
        J Surg Res. 2019; 236: 110-118
        • Zuckerberg G.S.
        • Scott A.V.
        • Wasey J.O.
        • et al.
        Efficacy of education followed by computerized provider order entry with clinician decision support to reduce red blood cell utilization.
        Transfusion. 2015; 55: 1628-1636
        • Meyer M.J.
        • Dzik W.H.
        • Levine W.C.
        Reduction in operating room plasma waste after evidence-based quality improvement initiative.
        Anesth Analg. 2018; 126: 1662-1665
        • Zuegge K.L.
        • Bunsen S.K.
        • Volz L.M.
        • et al.
        Provider education and vaporizer labeling lead to reduced anesthetic agent purchasing with cost savings and reduced greenhouse gas emissions.
        Anesth Analg. 2019; 128: e97-e99
        • Childers C.P.
        • Maggard-Gibbons M.
        Understanding costs of care in the operating room.
        JAMA Surg. 2018; 153e176233
        • Practice Greenhealth
        Sustainability Benchmark Report.
        Date: 2021

      Linked Article

      • A call to arms to implore surgeons to be involved in managing operating room waste
        SurgeryVol. 171Issue 5
        • Preview
          When asked to provide a cogent review of an article submitted to Surgery on operating room waste, I had hesitancy based on not being a content expert. I read the abstract and then thought to myself: How many times at the end of a case have I taken all the drapes, gloves, and so on, including many items which were not used, and piled them up in the waste basket? I also reflected back on a time when I performed a number of time at the University of Virginia Health Care system, where I performed a number of carotid endartectomies, mostly without shunts, primarily to see the shunts thrown out at the end of case unused.
        • Full-Text
        • PDF