Decarbonizing the Operating
Room
Emily Johnson, MD, MSc
Introduction
I have no conflicts of interest or discloses.
Objectives
1. Provide brief overview of climate change and explain how climate
change impacts human health
2. Describe how the healthcare sector contributes to climate change
3. Discuss opportunities to limit the environmental impact of surgery
CO
2
CH
4
That’s us!
Climate change & human health
Heat-related
illness
Extreme weather-
related injury
Malnutrition &
food insecurity
Air quality &
respiratory illness
Infectious disease
Mental health disorders
& displacement
Climate change
will be the
greatest threat
to human health
in the 21
st
century.
Climate and Health Assessment, U.S. Global Change Research Program, 2016, https://health2016.globalchange.gov/
8-10% of U.S.
greenhouse
gases
4 billion pounds landfill
bound waste annually
470,000 disability
adjusted life years lost
annually
U.S. Healthcare Sector
Eckelman, M. J., & Sherman, J. (2016). Environmental impacts of the US health care system and effects on public health. PloS one, 11(6), e0157014.
Chung, J. W., & Meltzer, D. O. (2009). Estimate of the carbon footprint of the US health care sector. Jama, 302(18), 1970-1972.
Greenhouse Gas Protocol in the operating room
1 2 3
Direct emissions
Anesthetic gases
Indirect emissions
from electricity
HVAC, lighting
Other indirect
emissions
Supply chain, waste
disposal
[Scope 1] Anesthetic Gas
4-63% of CO2 emissions
[Scope 2] Energy
17-84% of CO2 emissions
[Scope 3] Supply chain & waste
12-20% of CO2 emissions
MacNeill, A. J., Lillywhite, R., & Brown, C. J. (2017). The impact of surgery on global climate: a carbon footprinting
study of operating theatres in three health systems. The Lancet Planetary Health, 1(9), e381-e388.
146-232 kg CO
2
Eq
Operating Rooms
Anesthetic Gases
1
Inhaled Gas
GWP
20
Carbon Dioxide (ref)
1
Sevoflurane
349
Isoflurane
1401
Desflurane
3714
Nitrous Oxide
289
Ryan, S. M., & Nielsen, C. J. (2010). Global warming potential of inhaled anesthetics:
application to clinical use. Anesthesia & Analgesia, 111(1), 92-98.
• Lowest fresh gas flows
• Anesthetic choice
• Waste anesthetic gas
capture/destruction
Quality Metrics
Multicenter Perioperative Outcomes Group, Sustainability Quality Metric, https://mpog.org/files/quality/measures/SUS-01_spec.pdf
SUS 01 – Percentage
of cases with mean
fresh gas flow (FGF)
equal to or less than
3L/min during
administration of
halogenated
hydrocarbons or
nitrous oxide.
Energy (HVAC*, lighting)
2
• Occupancy-based HVAC setbacks
• LED lighting
• Renewable energy investment
Practice Greenhealth, 2019 Sustainability Benchmark Data,
https://practicegreenhealth.org/sites/default/files/2019-11/2019_sustainability_benchmark_data.pdf
*HVAC = heating, ventilation, & air conditioning
Median annual cost
-savings
HVAC setback, per OR
$2,585
HVAC setback, per facility
$33,604
LED lighting, per OR
$166
LED lighting, per facility
$4,380
Supply chain and waste management
3
• Reduce, reuse, recycle
• Reprocess
Reduce/reuse opportunities
Reusable gowns, textiles &
basins
Reusable hard cases for surgical
instrumentation
OR kit reformulation
Reusable sharps containers
Thiel, Cassandra L., et al. "Cataract surgery and environmental sustainability: waste and lifecycle assessment of
phacoemulsification at a private healthcare facility." Journal of Cataract & Refractive Surgery 43.11 (2017): 1391-1398.
16-25x lower
emissions
Metro Health
Reprocessed Devices
Supply chain and waste management
3
• Reduce, reuse, recycle
• Reprocess
• Biohazard waste management
• Environmentally preferred purchasing
8x more expensive
>90% miscategorized
Environmentally Preferred Purchasing
Involving employees
83%
17%
Health System
80%
20%
Operating Rooms
Yes
No
Green teams & sustainability champions
Beaumont Hospital
Recommendations
1. Find out what already exists in your hospital
2. Review your hospitals current successes and opportunities for
improvement
3. Target high impact, low energy input solutions
4. Work with leadership to implement deeper changes
Thank you!
Email ehjohnso@med.umich.edu
