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Can we decarbonize surgical healthcare?

In 2021, President Biden pledged to cut domestic greenhouse gas (GHG) emissions 50 to 52 percent by 2030. To achieve this target, the administration intends to reduce tailpipe emissions and boost the efficiency of cars and trucks. Plans to decarbonize buildings by supporting energy efficiency upgrades and electrification are also in place.4 ways to save money on lumberUp Next: It’s an especially dangerous time to be a pedestrian in America

However, another area deserves attention: the US health care sector. In 2018, the GHG emissions of this $4.1 trillion sector reached 1,692 kilograms per capita, which is the highest rate among industrialized nations and about 25 percent of global health sector emissions. A 2020 study published in Health Affairs found the health care sector responsible for about 8.5 percent of the country’s total GHG emissions. 

Here’s how the medical community can play its role in climate change mitigation efforts by significantly reducing waste and carbon output.

The health care sector is an underestimated source of greenhouse gas emissions

Medical care often is carbon-intensive. It is an underappreciated contributor to GHG emissions, says Nicholas Berlin, national clinician scholar at the University of Michigan Institute for Healthcare Policy and Innovation. 

For example, he adds that surgery and anesthesia are highly carbon-intensive processes due to the use of volatile anesthetic gassessingle-use equipment, and energy-intensive technologies such as robotic-assisted procedures. A single operation is estimated to produce approximately 814 kilograms of carbon dioxide emissions, equivalent to that of driving 2,273 miles in an average combustion engine car.

GHG emissions can also stem directly from the operations of health care facilities, sources of energy, heating and cooling, and the supply chain of health care services and goods, says Victor J. Dzau, president of the National Academy of Medicine (NAM).

Increasing GHG emissions exacerbates global warming and significantly contributes to worsening air pollution, increased frequency of extreme weather events such as wildfires and heatwaves, and disrupted food systems. These environmental impacts result in various health threats, such as asthma, food, water, vector-borne diseases, and malnutrition. The health damages stemming from the pollution caused by the US health care sector are estimated to be the same degree as the deaths from preventable medical errors.

“It must be underscored that the health impacts of climate change are disproportionately and most acutely felt by people of color and historically marginalized and disenfranchised communities,” says Dzau. If global warming reaches 2 degrees Celsius, Black communities would be 40 percent more likely to live in areas with the highest projected increases in extreme temperature-related deaths. Meanwhile, Hispanic and Latino individuals would be 50 percent more likely to live in areas with the highest estimated increases in traffic delays because of increased coastal flooding. 

According to estimates by the World Health Organization (WHO), the direct damage cost of climate change to health would be about $2 to 4 billion per year by 2030. Decarbonizing health care is an opportunity to improve health for everyone and reduce the financial costs of care and disease burden, says Dzau.

Decarbonizing surgical care is possible

Surgery is a significant contributor to GHG emissions. The mean energy usage of operating rooms by surface area is three to six times that of the hospital building average. The use of heating, ventilation, and air conditioning (HVAC) systems to maintain a sterile surgical environment account for roughly 40 percent of health care emissions.

Fortunately, there are many structural opportunities to employ sustainable practices in surgical practice—specifically, surgical oncology health care—as outlined in a 2022 paper published in the Journal of Clinical Oncology. “If we are going to reduce emissions according to the objectives outlined by President Biden, then changes to the healthcare sector will inevitably play a critical role,” says Berlin, an author of the paper.

Widespread changes within a short period, if not thoughtfully implemented, may disrupt existing delivery systems and affect the quality of care. Therefore, he adds, we need to start with the “low-hanging fruit” first, like reducing the number of volatile anesthetic gasses used in operating rooms.

Inhaled anesthetic agents like nitrous oxide or desflurane account for more than half of emissions associated with surgical care. Nitrous oxide can persist in the atmosphere for 114 years. Meanwhile, desflurane has the highest global warming potential among inhaled anesthetic agents, and using it for an hour has the same carbon footprint as driving 230 miles.

Limiting wasteful single-use products in the operating room, like switching to reusable surgical gowns and reprocessed single-use devices instead of disposable gowns and virgin-produced medical devices, would also be beneficial.

Another strategy is to remove unnecessary or rarely used sterile instruments in standard procedural trays, which helps minimize waste and energy consumption related to instrument sterilization. A 2017 study published in the Journal of Neurosurgery found that the neurosurgical department at the University of California, San Francisco wasted $2.9 million in unused supplies annually. Some of the most frequently wasted surgical supplies include the Raytex sponge gauze, Surgifoam, and Surgicel Nu-Knit.

Choosing to source surgical supplies from local suppliers may also diminish the environmental impact of operating rooms by reducing the transport-related use of fossil fuels. Furthermore, Berlin recommends embracing telehealth as a convenient option and less carbon-intensive modality for patients with long travel distances. Compared to the average in-person visit, greater integration of telemedicine, wherever appropriate, minimizes emissions per appointment by 40 to 70 times because it reduces the carbon costs of traveling to and from the clinic by car or taxi services.

“Altogether, improving the carbon footprint of the entire healthcare ecosystem will have immense health, social, and economic benefits,” says Dzau. “[It] could serve as a catalyst for other sectors to improve their own carbon footprint and sustainability efforts as well.”

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