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March 23, 2022

Green Operating Room—Current Standards and Insights From a Large North American Medical Center

Author Affiliations
  • 1Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
  • 2School of Medicine, Wayne State University, Detroit, Michigan
JAMA Surg. 2022;157(6):465-466. doi:10.1001/jamasurg.2022.0140

Climate change poses an imminent threat to environmental and public health. Despite recent efforts to decrease our carbon footprint, the United States remains one of the highest contributors to this problem, ranking second in greenhouse gas emissions and energy usage worldwide.1,2 Health care alone accounts for nearly 10% of this energy expenditure.2 Within hospitals, operating rooms (ORs) produce a disproportionate amount of greenhouse gases and disposable waste and consume an inordinate amount of energy. Recent studies attribute more than 30% of hospital medical waste to ORs and estimate their energy intensity, defined by amount of energy used per occupied space, to be 3 to 6 times that of a hospital in its entirety.3,4

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1 Comment for this article
Environmental Sustainability aligns with Financial Stewardship in the OR
Matthew Meyer, MD | University of Virginia School of Medicine
We congratulate Dr. Anand and co-authors on a wonderful publication,1 and we especially laude the emphasis that sustainability initiatives result in financial savings. Historically, a counterargument to sustainability in the OR was that it would increase costs. While this reasoning was never true when considering population health,2 the “green” OR efforts summarized in this manuscript result in direct health system cost-savings; thus, demonstrably linking OR sustainability with cost-savings.

We appreciate the acknowledgement of single-use items as a significant contributor to OR waste. While recycling and reprocessing supplies can be more sustainable options, the most sustainable option is to
avoid making the waste in the first place. In the OR, there is the phenomenon of unnecessary waste—when items are opened but unused for the procedure—and we want to emphasize this area as a particularly troubling but actionable cause of waste. Unnecessary waste is most obvious on the scrub table.

When surgeons were asked to identify a change that could be implemented immediately to reduce OR waste, over 50% identified the problem of opened but unused sterile surgical items. They also estimated that 26% of single-use, sterile surgical supplies that were opened on the scrub table were never used.3 Previous studies show that 50-80% of sterile instruments go unused during surgery, and each instrument costs $0.51 to $3.19.4 Furthermore, a study from UCSF in 2016 calculated that the department of neurosurgery could save $2.9 million if it simply avoided unnecessary waste of sterile surgical supplies.5

Over 90% of surgeons report a willingness to adjust their workflow in order to reduce waste in the OR. They identify the largest barriers to waste reduction as lack of awareness of waste, lack of concern for waste, and lack of time to address the waste.3 Our lab is focusing on developing a technology that addresses these barriers and can help health systems and surgeons identify and reduce unnecessary waste of intraoperative sterile surgical supplies.

We hope that this positive correlation between health system sustainability initiatives and health system financial savings, as admirably demonstrated in this publication by Dr. Anand and co-authors, will serve as a strong incentive for the implementation of OR sustainability efforts throughout the world.


Natalie M. Goldfield BA, and Matthew J. Meyer MD

1. Anand SK, Culver LG, Maroon J. Green Operating Room-Current Standards and Insights From a Large North American Medical Center. JAMA Surg. Mar 23 2022;doi:10.1001/jamasurg.2022.0140
2. Eckelman MJ, Sherman J. Environmental Impacts of the U.S. Health Care System and Effects on Public Health. PLoS One. 2016;11(6):e0157014. doi:10.1371/journal.pone.0157014
3. Meyer MJ, Chafitz T, Wang K, et al. Surgeons' perspectives on operating room waste: Multicenter survey. Surgery. Jan 26 2022;doi:10.1016/j.surg.2021.12.032
4. Nast K, Swords KA. Decreasing operating room costs via reduction of surgical instruments. J Pediatr Urol. Apr 2019;15(2):153.e1-153.e6. doi:10.1016/j.jpurol.2019.01.013
5. Zygourakis CC, Yoon S, Valencia V, et al. Operating room waste: disposable supply utilization in neurosurgical procedures. J Neurosurg. Feb 2017;126(2):620-625. doi:10.3171/2016.2.JNS152442
CONFLICT OF INTEREST: MM is developing technology which may result in intellectual property related to identification and reduction of intraoperative waste.