Strategies to Reduce Greenhouse Gas Emissions from Laparoscopic Surgery

Abstract

Objectives: To determine the carbon footprint of various sustainability interventions used for laparoscopic hysterectomy.

Methods: We designed interventions for laparoscopic hysterectomy from approaches that sustainable health care organizations advocate. We used a hybrid environmental life cycle assessment framework to estimate greenhouse gas emissions from the proposed interventions. We conducted the study from September 2015 to December 2016 at the University of Pittsburgh (Pittsburgh, Pennsylvania).

Results: The largest carbon footprint savings came from selecting specific anesthetic gases and minimizing the materials used in surgery. Energy-related interventions resulted in a 10% reduction in carbon footprint per case but would result in larger savings for the whole facility. Commonly implemented approaches, such as recycling surgical waste, resulted in less than a 5% reduction in greenhouse gases.

Conclusions: To reduce the environmental emissions of surgeries, health care providers need to implement a combination of approaches, including minimizing materials, moving away from certain heat-trapping anesthetic gases, maximizing instrument reuse or single-use device reprocessing, and reducing off-hour energy use in the operating room. These strategies can reduce the carbon footprint of an average laparoscopic hysterectomy by up to 80%. Recycling alone does very little to reduce environmental footprint. Public Health Implications. Health care services are a major source of environmental emissions and reducing their carbon footprint would improve environmental and human health. Facilities seeking to reduce environmental footprint should take a comprehensive systems approach to find safe and effective interventions and should identify and address policy barriers to implementing more sustainable practices.

FIGURE 1—

Changes in Greenhouse Gas Emissions for a Single Hysterectomy From Proposed Sustainability Interventions Note. HVAC = heating, ventilation and air conditioning. Anesthetic interventions: A1 = desflurane alone; A2 = desflurane with N₂O; A3 = sevoflurane with N₂O; and A4 = sevoflurane alone. Material interventions: M1 = maximize recycling; M2 = maximize regulated medical waste; M3 = reuse all cotton towels; M4 = switch to reusable linens; M5 = reprocess single-use devices where possible; M6 = minimize surgical materials; and M7 = a combination of these material approaches. Energy interventions: E1 = install occupancy sensors; E2 = switch to a low-carbon electricity source; and E3 = a combination of these 2 features. ^aThe optimized “ideal” case includes sevoflurane only, minimum materials list, maximum reusable materials and recycling, occupancy sensors, and a low-carbon electrical grid. ^bAssuming a 150 min duration for use of desflurane and sevoflurane, and 16 min duration for use of N₂O, where original baseline case is average of anesthetic approaches used in original 17 laparoscopic hysterectomies. ^cEnergy impacts on the basis of average surgery duration of 170 min, these interventions present larger savings for the operating room per annum.