Waste in orthopaedic surgery; an application of the healthcare sustainability mode and effect analysis

Introduction: Operating theatres generate a lot of waste and as such are a major contributor to the rise of negative environmental impact of hospitals. Thus reducing operating room waste is an essential strategy for hospitals to reduce their environmental impact and contribute to a healthier environment. This study aims to quantify waste from six common orthopaedic
procedures and identify potential strategies for reduction.

Methods: The Healthcare Sustainability Mode and Effect Analysis (HSMEA) is a method to assess the environmental impact
of waste. It is a systematic approach to analyse waste, calculate the environmental impact and identify strategies to reduce
this impact. In this study an HSMEA of operating room waste of 18 orthopaedic procedures was performed: open and percutaneous spinal fusion (n=6), unicompartmental and total knee arthroplasty (n=6), reverse shoulder arthroplasty (n=3)
and total hip arthroplasty (n=3). For each type of waste, the strategies of the 6R methodology were considered to reduce the
environmental impact of the operating theatre department.

Results: The weight of the waste of orthopaedic procedures ranged between 6.35 and 8.30 kg. About 70% of the total waste
was plastic. The environmental impact of measured orthopaedic procedures ranged between 19.14 and 23.96 kg CO2-eq. The
impact of the six orthopaedic procedures could be reduced with 10.3 to 13.9 kg CO2-eq. using the 6R methodology.

Conclusion: The environmental impact of waste from orthopaedic procedures is substantial and can be reduced up to 63%.
Applying the HSMEA method to all procedures in the operating theatres can lead to a significant reduction of the carbon
footprint of hospitals.