Sustainable surgery can cut costs, reduce emissions, improve care, review finds

Editor's Note

Surgical teams can dramatically reduce healthcare’s carbon footprint through waste reduction, energy efficiency, and smarter procurement, Cureus October 7 reports. The review’s authors describe surgery as both a major environmental challenge and a key opportunity for hospitals to align climate responsibility with clinical and financial goals.

Healthcare contributes about 4.4% of global greenhouse gas emissions, with a carbon footprint comparable to the airline industry. Within that total, ORs account for 20%–33% of hospital waste while consuming three to six times more energy per square foot than other departments, the review reports. Single-use devices, high anesthetic gas emissions, and intensive water use further magnify surgery’s environmental toll. A single surgical case can require up to 300 liters of water and generate as much as 14 kilograms of waste.

The review details a range of solutions already in use. Waste segregation programs can cut regulated medical waste by up to 85%, and recycling initiatives divert as much as 30% of surgical waste from landfills. Optimizing custom procedure trays and reprocessing single-use devices can reduce waste by thousands of kilograms annually while saving 40%–50% in procurement costs. Energy-efficient measures such as LED lighting, smart HVAC systems, and heat recovery designs lower OR energy demand by up to 80%. The authors also highlight anesthetic gas management programs that replace or capture high–global-warming agents, reducing emissions equivalent to hundreds of cars per institution each year.

As detailed in the article, environmentally preferable purchasing programs and regional sourcing shorten supply chains and reduce packaging waste, while circular economy approaches extend instrument lifespans through refurbishment and materials recovery. However, barriers remain. Regulatory restrictions on reprocessing, high upfront costs, fragmented budgeting, and limited staff training continue to hinder implementation. Surveys cited show that most surgical staff underestimate OR resource use, and fewer than one-third have received sustainability training.

The authors recommend that hospitals establish sustainability committees, integrate environmental metrics into performance dashboards, and invest in efficient infrastructure. Clinicians can adopt low-flow or total intravenous anesthesia, use reusable instruments where safe, and engage in education initiatives. Policymakers are urged to create incentives, harmonize waste regulations, and embed sustainability into accreditation standards.