Michigan Medical School researchers searched for ways to reduce emissions and waste from hospital operating rooms.

A paper published in the Journal of Clinical Oncology looked at how hospitals can reduce greenhouse gas emissions from operating rooms.

University of Michigan Medical School student Victor Agbafe came up with the idea for the paper when he wanted to see what role the medical community, which accounts for about 8.5% of America’s greenhouse gas emissions, can play in climate change reduction efforts.

Co-written by Michigan Medicine integrated plastic surgery resident Nicholas Berlin, MD, MPH, MS, the paper describes how surgery, particularly cancer surgery, contributes to climate change and suggests solutions to combat the problem, from reducing waste to rethinking how surgical care is delivered.

According to the paper, operating rooms are a huge source of greenhouse gas production for hospitals, representing 70% of their waste and generating three to six times as much carbon as the rest of health systems.

Cancer care is an obvious target for greener efforts within surgery, Berlin notes, because it often involves intense levels of care over a short period.

Minimally invasive surgeries that require a lot of energy, including robotic-assisted operations, have become common treatments for cancers ranging from colorectal and uterine cancer to head and neck cancer. 

A robotic-assisted hysterectomy, for example, produces as much carbon as driving more than 2,200 miles in a car.

One of the most feasible changes to make in this space would be from waste reduction, Agbafe said.

Reducing waste might be as simple as ensuring that anything thrown away before or during surgery is properly categorized and labeled. It’s estimated that over 90% of OR waste does not meet the necessary standards for the type of trash it ends up in.

Hospitals could also consider switching to some reusable or reprocessed devices and surgical gowns since there is no link between reused tools and hospital-acquired infections.

Some of the pair’s other suggestions involve optimizing ORs’ energy use. Agbafe and Berlin point to the American Society of Healthcare Engineering’s recommendations to install energy-efficient lighting, schedule preventive maintenance, and minimize airflow into rooms that aren’t being used as easy ways to reduce emissions.

The paper also points to waste in procuring operating instruments, finding that about 87% of the surgical instruments laid out for an operation are rarely used. However, energy is still used to sterilize and repackage the instruments.

“Given some of the geopolitical events that have been going on right now in Ukraine and with China and the competition there along with the effects of pandemic is creating an increasing emphasis on resiliency within supply chains,” said Agbafe. “So this idea of localizing our operating room supply chains is something that there’s a lot of political energy and momentum within the public to move towards.”

The use of telemedicine was also seen as a tool to reduce the emissions impact of operations.

“We think telemedicine is a great opportunity for us to lower the climate impact and improve the quality of care by doing so,”  said Agbafe. “During the pandemic, we’ve been using virtual care and if we could make that a routine aspect of cancer care for pre-op and post-op, that’s a way we can reduce the climate impact of delivering care and make it more convenient for patients.”

The full paper is available online.

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