Hysterectomy's Environmental Footprint

Accounting for 17% of the US gross domestic product, the healthcare sector in large part drives our economic growth. Its large size also has an environmental impact, and that impact is disproportionately large. Hospitals and healthcare providers generate large amounts of waste with the endless number of single-use supplies. They also use vast quantities of electricity, and when machines age or are replaced by new technology—events that occur with alarming speed—they become disposal problems (eg, hospitals are the leading source of environmental mercury).

Most health care organizations have started to lessen their environmental impact slowly. They are tackling small problems and making manageable changes. A multidisciplinary team of researchers from across the US carved out one surgical procedure to determine environmental impact. Their assessment of abdominal, vaginal, laparoscopic, and robotic hysterectomy appears ahead of print in the journal Environmental Science and Technology.

Environmental efficiency improvements can reduce costs, resource use, and waste without compromising patient care. This paper is a small step toward providing evidence of the impact of environmental awareness on healthcare. The authors chose this topic because operating rooms are the hospital’s most resource-intensive area. They used hybrid life cycle assessment to quantify environmental emissions associated with the 4 surgical approaches to hysterectomy. The process they used to calculate the cradle-to-grave cost of each procedure is quite engaging and well-depicted in a flow chart.

They analyzed 62 hysterectomies and determined specific environmental impacts (e.g. plastic, glass, paper, metal, and cotton). Major sources of environmental emissions include the production of disposable materials and single-use surgical devices; energy used for heating, ventilation, and air conditioning; and anesthetic gases.

Among the 4 procedures, robotic hysterectomy created the most waste in kilograms. It was particularly wasteful of hard plastics and paper compared to other procedures.

They estimate that in the US, greenhouse gas emissions pursuant to hysterectomies are roughly 212,000 metric tons of carbon monoxide equivalents annually. Recycling rates were low, a finding the authors attribute to a lack of time in the operating room. They suggest this is an area for improvement.

The authors suggest that choosing an environmentally-preferred anesthetic choice and avoiding excessive fresh gas flow rates could reduce greenhouse gas emissions and ozone depletion potential from hysterectomies by 65% to 95% for abdominal and vaginal hysterectomies. Switching to propofol or other IV or regional anesthesia techniques where clinically indicated would reduce ozone depletion potential 3% in laparoscopic and 28% in robotic hysterectomies.