Carbon footprint reduction of the operating room: tools to mitigate the environmental impact of surgical practice

Abstract

Background: Healthcare contributes substantially to greenhouse gas emissions, with operating rooms (ORs) representing an important target for decarbonization because of their high energy consumption, resource use, and waste production. This thesis investigated strategies to reduce the carbon footprint of ORs without compromising patient safety.

Methods and Results: The environmental impact of key OR emission sources was assessed across Scopes 1–3 using life-cycle assessment and other quantitative approaches. Inhalational anaesthetics were identified as an important source of direct emissions, although their impact in the Netherlands was relatively limited due to low use of nitrous oxide and desflurane and a preference for intravenous propofol. For cardiac surgery, no evidence was found that unidirectional airflow reduced surgical-site infections compared with turbulent mixed airflow, despite substantially higher energy consumption. Reusable rigid sterilization containers had an 85% lower carbon footprint than disposable blue wrap. Transfemoral transcatheter aortic valve implantation had a 38% lower carbon footprint than surgical aortic valve replacement.

Conclusions: Practical tools, including HSMEA and SCALE, can identify emission hotspots and guide effective interventions. Six high-impact measures accounted for more than 95% of achievable OR emission reductions. Future efforts should prioritize Scope 3 emissions and the transition towards a circular healthcare economy.