How RCSI research is reducing surgery's environmental impact

In response to a mounting global increase in hip and knee arthroplasties, a team of RCSI researchers sought to quantify the waste generated by these surgeries and determine their environmental and economic impact. Their research offers a roadmap to a green operating room without compromising infection control or patient safety.

Osteoarthritis, a degenerative joint disease often linked to ageing, has seen a dramatic rise globally. According to the 2019 Global Burden of Disease, the prevalence of osteoarthritis surged 113.25% from 1990 to 2019, with numbers rising from 247.51 million to 527.81 million cases. In Ireland alone, approximately 400,000 people currently live with osteoarthritis, making hip and knee arthroplasties – the gold standard treatment – agrowing necessity.

With the increase in orthopaedic operations comes an increase in clinical, domestic, and recycled waste. Operating theatres have been found to account for up to 70% of the overall waste produced in hospitals. A substantial portion of osteoarthritis waste is attributed to unused supplies that have been opened and improperly sorted, including materials that have potential for recycling.

In addition to this, the field of orthopaedic surgery has seen huge technological advances in instruments and implants. The growth in the range of prostheses and inventory brings with it an increase in packaging. This waste negatively impacts both environmental and human health as improper waste disposal influences air quality which can lead to further disease in the community.

At the National Orthopaedic Hospital Cappagh, the largest elective orthopaedic hospital in the Republic of Ireland where over 3,000 operations are performed annually, this challenge is particularly significant. In response, Professor John M. O'Byrne, Abraham Colles Professor of Trauma and Orthopaedic Surgery at RCSI and Consultant Trauma and Orthopaedic Surgeon led a new RCSI study, ‘The environmental impact of hip and knee arthroplasty: An analysis of carbon emissions and disposal costs’ which set out to monitor the waste output of operating theatres at the hospital.

The researchers looked specifically at the waste generated by hip and knee replacement surgeries which produce a considerable amount of clinical, domestic and recycled waste largely stemming from the packaging of implants, infection control measures and other factors. The numbers are stark: primary knee replacements generate an average of 15.82 kgs of CO2 emissions per procedure, and primary hip replacements generate 14.64 kgs. Revision surgeries – more complex procedures requiring additional instruments and more implants – generated even more at 23.58 kgs CO2. Notably, cohesive bandage compression wraps alone contribute, on average, 13.5% of total operating room waste.

The paper asks surgical teams to examine current waste creation and management in their theatres and reduce waste generation without compromising patient safety and infection control. The paper also calls for the role of single use instruments to be examined, while also acknowledging that the reuse of instruments and the sterilisation process is clearly not without its own environmental impact.

The findings have already inspired change at the National Orthopaedic Hospital Cappagh and provide a roadmap for operating theatres across the system. Operating room personnel are increasingly examining pre-packaged sets, to see if some of the contents are rarely (or, indeed, never) used. The issue of single use items versus re-sterilizing and recycling instruments is also being explored by theatre staff, as is the management of large amounts of material that are wrapped around sterile surgical sets, with an eye towards more sustainable solutions.

You can read the full paper which was published in ScienceDirect journal here.