Startling figures spotlight an urgent challenge for healthcare – reducing its ecological footprint without compromising the quality of patient care.
New research shows that single anterior cruciate ligament (ACL) reconstruction generates a staggering 47kg of carbon dioxide equivalent (CO2eq) – the same as driving a petrol-fuelled car 120 miles.
Multiply that by the 130,000 ACL surgeries performed annually in the US, and the carbon footprint balloons to 6,110 metric tons of CO2eq, equivalent to 15 million miles driven.
These eye-watering figures are part of a new study that exposes the significant carbon footprint of surgical procedures and the hidden environmental costs of modern medicine.
Led by researchers at the University of Pittsburgh, the study is a tribute to the late Dr Freddie H. Fu, a pioneering orthopaedic surgeon whose forward-thinking legacy inspires innovation in medicine.
The researchers used a meticulous life-cycle assessment approach to uncover the environmental ripple effects of ACL surgery – from sourcing raw materials to disposal.
Their analysis uncovered other surprising insights into the environmental impact of operating rooms.
For example, disposable cotton towels contributed 9% to global warming potential, laparotomy sponges 1%, and disposable plastics like surgical drapes 6%.
The biggest contributor, responsible for 58% of the impact, was the production of surgical products.
Energy use for operating room equipment and HVAC systems added 10% and 14%, respectively.
Other factors included autoclaving steel instruments (9%), laundering linens (4%), and waste disposal (1%).
The findings highlight the urgent need for sustainable improvements in surgical practices and operating room management.
Dr Melissa Bilec is the special assistant to the Provost for Sustainability at the University of Pittsburgh and was the first to apply this process to examining hospital-room infant births in 2012 in a study with UPMC Magee-Womens Hospital.
‘While life-cycle assessment and material flow analysis (MFA) are tools in engineering and sustainability research, their potential has only recently been adapted to understanding the incredible impact that health care has on climate,’ she said.
This cradle-to-grave assessment takes a hard look at every product and process involved – in this case, with ACL surgery, everything from the materials used to make the devices used in surgery to the energy consumed and the cost of disposing of the material.
She added that partnerships with Pitt and UPMC are critical to advancing the collective strategic climate and achieving environmental goals.
Greenhouse gas emissions might appear easy to understand, but according to first author Nathalia Cano, conducting an LCA on a complex process such as constructing a building or performing surgery results in astonishing carbon footprints.
‘As health professionals and researchers, we must explore ways to make our practices more sustainable without compromising patient outcomes. With LCA and MFA as our toolbox, we examined scenarios throughout the operation to reduce environmental impact, including reducing resources, optimising surgical practices, and exploring innovative materials and circular economy approaches.’
Ian Engler, orthopaedic sports medicine surgeon at the Central Maine Medical Centre, said: ‘Though the most critical priority in surgery is excellent patient care, surgeons can and should also be mindful of the carbon footprint of our surgeries. We make many decisions in patient care that lead to a big environmental footprint, and this research helps us guide efforts to integrate sustainability into orthopaedic surgery.’
The paper was published in Clinical Orthopaedics and Related Research.
