Abstract
Background
Climate change is a significant public health threat. Health care comprises 10% of
greenhouse gas emissions in the United States, where surgery is especially resource
intensive. We did a systematic review to assess and summarize the published evidence
of the environmental impact of surgery.
Methods
We searched Medline, Embase, Web of Science, and GreenFILE databases for publications
that report any environmental impact measure by all surgical subspecialties, including
anesthesia. Inclusion criteria were published in English, original research, and passed
peer review. Because data were heterogeneous and the aim was broad, we conducted a
qualitative summary of data. Where possible, we compare impact measures.
Results
In the study, 167 articles were identified by our search strategy and reviewed, of
which 55 studies met criteria. Eight were about anesthesia, 27 about operating room
waste, and 6 were life cycle assessments. Other topics include carbon footprint and
greenhouse gas emissions. Nine papers fell into 2 or more categories. Overall, the
operating room is a significant source of emissions and waste. Using anesthetic gases
with low global warming potential reduces operating room emissions without compromising
patient safety. Operating room waste is often disposed of improperly, often due to
convenience or knowledge gaps. There are environmental benefits to replacing disposable
materials with reusable equivalents, and to proper recycling. Surgeons can help implement
these changes at their institution.
Conclusion
Although there is a clear need to lower the carbon footprint of surgery, the quality
of research with which to inform protocol changes is deficient overall. Our attempt
to quantify surgery’s carbon footprint yielded heterogeneous data and few standardized,
actionable recommendations. However, this data serves as a starting point for important
future initiatives to decrease the environmental impact of surgery.
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Article info
Publication history
Published online: July 01, 2022
Accepted:
April 5,
2022
Footnotes
M.A.S. and N.M.B. contributed equally to this article.
Identification
Copyright
Published by Elsevier Inc.
