학술논문
Carbon Footprint of Minor Foot and Ankle Surgery: A Randomized Controlled Trial.
Document Type
Academic Journal
Author
Parker EB; Harvard Medical School, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.; Bluman EM; Harvard Medical School, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.; Chiodo CP; Harvard Medical School, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.; Martin EA; Harvard Medical School, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.; Smith JT; Harvard Medical School, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.
Source
Publisher: Sage Publications Country of Publication: United States NLM ID: 101752333 Publication Model: eCollection Cited Medium: Internet ISSN: 2473-0114 (Electronic) Linking ISSN: 24730114 NLM ISO Abbreviation: Foot Ankle Orthop Subsets: PubMed not MEDLINE
Subject
Language
English
Abstract
Background: Climate change poses a substantial threat to human health, and operating rooms (ORs) have an outsized environmental impact. The Program for Research in Sustainable Medicine (PRiSM) designed a protocol for minor foot and ankle surgery intended to reduce waste, streamline instrument trays, and minimize laundry. We conducted a randomized controlled trial to compare the carbon footprint of procedures performed using the PRiSM protocol vs a traditional protocol.
Methods: Forty adult patients undergoing foreign body removal, hammertoe correction, toe amputation, hardware removal, mass excision, or gastrocnemius recession were randomized to the PRiSM or our "Traditional" protocol. The PRiSM protocol used a smaller instrument tray, fewer drapes and towels, and minimal positioning blankets. No changes were made to surgical site preparation or operative techniques. Environmental impact was estimated using the carbon footprint, measured in kilograms of carbon dioxide equivalents (CO2 e). Emissions associated with OR waste, instrument processing, and laundry were calculated.
Results: On average, PRiSM cases had a smaller carbon footprint than Traditional cases (17.3 kg CO2e [SD = 3.2] vs 20.6 kg CO2 e [SD = 2.0], P < .001). Waste-associated emissions from PRiSM cases were reduced (16.0 kg CO 2 e [SD = 2.7] vs 18.4 kg CO 2 e [SD = 1.8], P = .002), as were modeled instrument processing-related emissions (0.34 vs 0.91 kg CO 2 e). One superficial surgical site infection occurred in each group.
Conclusion: We found a small but statistically significant reduction in the environmental impact of minor foot and ankle surgery when using the PRiSM vs Traditional protocol. The environmental impact of these cases was dominated by plastic waste-related emissions. Orthopaedic surgeons should think critically about what components of their surgical setup are truly necessary for patient care, as minor changes in product utilization can have significant impacts on waste and greenhouse gas emissions.
Level of Evidence: Level I, randomized controlled trial.
Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.
(© The Author(s) 2024.)
Methods: Forty adult patients undergoing foreign body removal, hammertoe correction, toe amputation, hardware removal, mass excision, or gastrocnemius recession were randomized to the PRiSM or our "Traditional" protocol. The PRiSM protocol used a smaller instrument tray, fewer drapes and towels, and minimal positioning blankets. No changes were made to surgical site preparation or operative techniques. Environmental impact was estimated using the carbon footprint, measured in kilograms of carbon dioxide equivalents (CO
Results: On average, PRiSM cases had a smaller carbon footprint than Traditional cases (17.3 kg CO2e [SD = 3.2] vs 20.6 kg CO
Conclusion: We found a small but statistically significant reduction in the environmental impact of minor foot and ankle surgery when using the PRiSM vs Traditional protocol. The environmental impact of these cases was dominated by plastic waste-related emissions. Orthopaedic surgeons should think critically about what components of their surgical setup are truly necessary for patient care, as minor changes in product utilization can have significant impacts on waste and greenhouse gas emissions.
Level of Evidence: Level I, randomized controlled trial.
Competing Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. ICMJE forms for all authors are available online.
(© The Author(s) 2024.)