Two surgeons-in-training suggest some sustainable solutions for climate change in their energy-intensive discipline
In April 2021, during the Leaders Summit on Climate, President Biden announced his goal to drastically reduce the United States’ greenhouse gas emissions by 2030.
Victor Agbafe was watching the address on TV. The University of Michigan Medical School student, who is also studying law at Yale, immediately texted a few mentors, including Michigan Medicine integrated plastic surgery resident Nicholas Berlin.
The question that emerged from their messages was a crucial one: What role can the medical community, which accounts for about 8.5% of America’s greenhouse gas emissions, play in these climate change reduction efforts?
A year later, research that Agbafe and Berlin led outlines some answers. Their paper describes how surgery, particularly cancer surgery, contributes to climate change and suggests some solutions to combat the problem, from reducing waste to rethinking how surgical care is delivered.
“In general, these ideas are good for our planet,” Agbafe said. “But also, surgery unfortunately plays a disproportionate role in the carbon output and the waste we produce in medicine.”
Operating rooms are a massive source of greenhouse gas production for hospitals, representing 70% of their waste and generating three to six times as much carbon as the rest of health systems.
Cancer care is an obvious target for greener efforts within surgery, Berlin notes, because it often involves intense levels of care over a short period of time.
Plus, minimally invasive surgeries that require a lot of energy, including robotic-assisted operations, have become common treatments for cancers ranging from colorectal and uterine cancer to head and neck cancer. A robotic-assisted hysterectomy, for example, produces as much carbon as driving more than 2,200 miles in a car.
“If we can lower our greenhouse gas output, we have a chance to extend the lifespan of our patients and expand access to timely care,” Agbafe said. “And we think it’s really important that the surgical community is proactive at being at that table.”
What to do differently
One of the most feasible changes to make in this space would be around waste reduction, Agbafe said.
This might be as simple as making sure that anything thrown away before or during surgery is properly categorised and labelled since it’s estimated that over 90% of OR waste does not meet the necessary standards for the type of trash it ends up in. (The red waste bags in ORs are intended only for items that have been exposed to bodily fluids and are much more expensive to dispose of than clear disposal bags.)
Hospitals could also consider switching to some reusable or reprocessed devices and surgical gowns since there is no link between reused tools and hospital-acquired infections.
Some of the pair’s other suggestions involve optimising ORs’ energy use. Agbafe and Berlin point to the American Society of Healthcare Engineering’s recommendations to install energy-efficient lighting, schedule preventive maintenance and minimise air flow into rooms that aren’t being used as easy ways to green the systems.
The surgical supply chain could be more efficient, too, they write. Estimates suggest that 87% of the surgical instruments laid out for an operation are rarely used, so coming up with standardised lists of the necessary tools for surgeries that occur regularly could cut down on cost, waste and the energy needed to sterilise and repackage those instruments.
Moving more manufacturing of surgical supplies closer to hospitals — or choosing to source from suppliers that are locally based — could also reduce the OR’s carbon footprint.
“Given some of the geopolitical events that have been going on right now in Ukraine and with China and the competition there along with the effects of pandemic is creating an increasing emphasis on resiliency within supply chains,” Agbafe said. “So this idea of localising our operating room supply chains is something that there’s a lot of political energy and momentum within the public to move towards.”
Reimagining care delivery
But perhaps the broadest way the oncology space could cut down on its greenhouse gas emissions is to change how surgical care is del