Carbon Footprint of Open Carpal Tunnel Release Surgery Performed in the Procedure Room Versus Operating Room Setting

Olivia Grothaus; Anna Jorgensen; Gretchen Maughan; Mercedes Anto; Nikolas H Kazmers; Brittany N Garcia

doi:10.1016/j.jhsa.2024.03.014

Carbon Footprint of Open Carpal Tunnel Release Surgery Performed in the Procedure Room Versus Operating Room Setting

J Hand Surg Am. 2024 May 6:S0363-5023(24)00147-3. doi: 10.1016/j.jhsa.2024.03.014. Online ahead of print.

Authors

Olivia Grothaus¹, Anna Jorgensen², Gretchen Maughan², Mercedes Anto², Nikolas H Kazmers², Brittany N Garcia²

Affiliations

¹ Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT. Electronic address: Olivia.grothaus@hsc.utah.edu.
² Department of Orthopaedic Surgery, University of Utah Health, Salt Lake City, UT.

PMID: 38713110
DOI: 10.1016/j.jhsa.2024.03.014

Abstract

Purpose: Environmental sustainability is an important issue in health care because of large amounts of greenhouse gases attributable to hospitals. The operating room has been highlighted as one of the highest contributors, prompting several initiatives by organizations focused on the care of hand and upper extremity conditions. This study aimed to quantify and compare the carbon footprint of a common hand surgery in two different surgical settings, the procedure room (PR) and operating room. We hypothesized that open carpal tunnel release (oCTR) will generate a greater environmental impact in the operating room than in the PR.

Methods: This was a retrospective review of oCTRs performed at a tertiary care medical center. Current procedural technology codes isolated a single cohort of patients who underwent bilateral oCTR, one side performed in the PR and the contralateral side in the operating room. Current published emission conversions were used to calculate carbon footprint at our institution based on energy expenditure necessary for the creation and disposal of waste and sterilization of surgical equipment. Surgery time was combined with heating, ventilation and air conditioning/lighting energy consumption to estimate facility emissions.

Results: Fourteen patients had bilateral oCTR surgery performed in both settings. Open CTR performed in the operating room generated 3.7 kg more solid waste than when performed in the PR. In total, emissions from oCTR performed in the operating room generated 32.4 kg CO₂, whereas oCTR in the PR emitted 13.0 kg CO₂ per surgery.

Conclusions: Performing a common hand procedure (oCTR) is more environmentally sustainable in the PR than in the operating room, with a 60% reduction in carbon footprint.

Clinical relevance: Greater effort should be made to perform surgery in the PR instead of the operating room in appropriately indicated patients. Surgical sets should be evaluated for the necessity of included equipment and unnecessary waste.

Keywords: Carbon emissions; WALANT; carpal tunnel release; environmental sustainability; procedure room.