Who owns the waste created in orthopaedic surgery?

Abstract

Background: The health care industry creates tremendous amounts of waste and emissions, and operating rooms are the single largest contributor. Single-use devices and other disposable plastic products have become a mainstay in modern hospital culture, particularly in the United States and other high-income countries. The creation and disposal of such items have major impacts on the environment and disproportionately affect vulnerable populations globally.

Review: Waste is a difficult term to define, and its meaning varies depending on cultural context and associated economic implications. The disposal, reprocessing, and recycling of waste streams particularly hazardous waste are energy intensive. Practices differ considerably across health systems depending on local guidance, incentives, and regulations. Governing and regulatory bodies disagree in their opinions and policies regarding the safety and reusability of medical equipment and products.

Conclusions: Accountability and ownership of health care waste continue to be somewhat ambiguous. Identifying stakeholders and potential opportunities for optimization and clarification is imperative. Auditing waste, designing scalable interventions, and innovation will be keys to reducing our contributions to environmental degradation. Significant economic implications and potential cost savings have been demonstrated when health care waste is reduced. Such savings can motivate the creation of lean, green operative practices and systems. Orthopedic surgeons have a unique, powerful opportunity to lead the way in thoughtful actions and innovation in this area.

Key concepts: (1)Health systems generate tremendous amounts of waste, and roughly 1/3 of this originates in operating rooms.(2)A throwaway culture and fear of contamination has led to increasing reliance on disposable and single use items-a trend that drives mounting costs, waste, and vulnerability to supply chain disruptions without clear benefit to patients.(3)Accountability for undue waste belongs to surgeons, health systems, industry, and society as a whole, but current regulations and guidelines surrounding waste classification, ownership, and disposal remain unclear and vary across health systems and locations.(4)Orthopaedic surgeons play an active role in waste generation by way of their instrument and product utilization; they can and should take ownership of existing opportunities to reduce overconsumption and promote reuse and recycling where appropriate.

Keywords: Carbon footprint; Circular economy; Recycle; Single-use devices; Sustainability.

Figure 1

Key stakeholders of the waste incurred in orthopedic surgery.

Figure 2

Representation of various phases of the waste audit cycle in health care .

Figure 3

Applying the 5R’s to orthopedic surgery as described by Phoon et al. . SUD, single-use device.

Figure 4

High-yield tips for orthopedic surgeons to promote waste reduction in the OR. SUD, single-use device; OR, operating room. DME, Durable medical equipment.