Carbon Footprint of Open Carpal Tunnel Release Performed in the Procedure Room versus Operating Room Setting
Anna Jorgensen, MD1,2, Olivia Grothaus, MD1, Gretchen Maughan, MS1, Mercedes Anto, BA1, Nikolas H. Kazmers, MD, MSE1 and Brittany N. Garcia, MD3, (1)University of Utah, Salt Lake City, UT, (2)Maine Medical Center, South Portland, ME, (3)University of Utah Hospital, Salt Lake City, UT
Introduction:
Environmental sustainability is an important issue in healthcare due to the large amount of greenhouse gases that are attributable to hospital waste. The operating room has been highlighted as one of the worst contributors within the hospital system, prompting the “Lean and Green Initiative� put forth by the ASSH, AAHS, ASPNS and ASRM in 2015, calling on our surgical specialty to prioritize environmental sustainability. This study aims to quantify and compare the carbon footprint of performing a common hand surgery in two different settings, the procedure room (PR) and the operating room (OR). We hypothesized that open carpal tunnel release (oCTR) in the OR will generate a greater environmental impact than those performed in the PR.
Materials and Methods:
This was a retrospective review of oCTRs performed at a tertiary care medical center. We utilized current proceduraltechnology codes to isolate a single, matched cohort of patients who underwent bilateral oCTR, with one side performed in the PR and the contralateral side performed in the OR. Current published and accepted emissions conversions were used to calculate carbon footprint at our institution based on energy expenditure necessary for creation and disposal of waste and sterilization of surgical equipment. Information from our patient cohort including surgery time and zip codeswas combined with heating, ventilation, and air conditioning (HVAC)/lighting energy consumption to estimate facility and travel emissions.
Results:
Fourteen patients had bilateral oCTR surgery performed in different settings. oCTR performed in the OR generated 3.7 kg more waste than when done in the PR. In total emissions, an open CTR in the OR generates 42.9 kg of CO2 in emissions while an open CTR in the PR emits 23.5 kg CO2. Total emissions for each evaluated category are presented in Table 1.
Conclusions:
This study shows that performing a common hand procedure (oCTR) in the PR is more environmentally sustainable than the same operation in the OR with a45% reduction in carbon footprint for each CTR performed in the PR. Greater effort should be made to perform surgery in the PR instead of the OR in appropriately indicated cases. Additionally, surgical sets need to be evaluated for necessity of included instrumentation/equipment.
Table 1
| Table 1. Average CO2 Emissions (KgCO2) Per Surgery | |||
| | OR | PR | Difference |
| Waste Disposal | 2.809 | 0.644 | 2.165 |
| Disposable Manufacturing | 15.89 | 9.1 | 6.76 |
| HVAC/Lighting Procedure | 2.09 | 0.184 | 1.906 |
| Sterilization | 11.55 | 3.05 | 8.5 |
| Patient Travel | 10.53 | 10.53 | 0 |
| Total | 42.869 | 23.508 | 19.361 |
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