What Otolaryngologists Can Do to Lessen Their Carbon Footprint

by Amanda E. Dilger, MD, Neelima Tummala, MD, and Natalie A. Krane, MD •

Tray reformulation can decrease not only waste, but also cost, by an average of $9,524 per OR annually.

Achieving Carbon Neutrality

Given the well-documented and worsening effects of climate change on public health, it’s imperative that all healthcare providers, including otolaryngologists, take conscious and meaningful steps toward carbon neutrality. Being carbon neutral means that your practice emits the same amount of carbon dioxide into the atmosphere that it offsets by other means. 

While there are many data-driven sustainability initiatives that, when taken together, can help a healthcare practice come closer to carbon neutrality and yield a net savings of $56,000 per operating room annually (bit.ly/greeningtheor), the following three are most applicable to otolaryngology:

  • Redesigning surgical trays to eliminate redundant and/or unused items. Tray reformulation can decrease not only waste, but also cost, by an average of $9,524 per OR annually. One study of tonsillectomy and adenoidectomy trays in a pediatric tertiary care hospital found that 12 of the 40 disposable items in the current trays weren’t being utilized, and removal of these items could decrease hospital waste production by 1.48 tons annually (Otolaryngol Head Neck Surg. 2012;147:615-618). Given the low infection risk of certain cases such as tonsillectomies, adenoidectomies, direct laryngoscopies, and nasal endoscopies, removal of excess disposable drapes from trays and conversion to field sterility (i.e., mask, sterile gloves, sterile drapes of surgical site only) can be considered. While the safety of field sterility has been established for hand surgery (Hand (N Y). 2011;6:60-63; Hand (N Y). 2019;14:808-813) and Mohs surgery (JAMA Dermatol. 2013;149:1378-1385), further research is needed to determine the role of field sterility in otolaryngology.
  • Reprocessing single-use items or replacing them with reusable alternatives. Given that the majority of otolaryngology cases are clean-contaminated, there are many opportunities for eliminating wasteful single-use devices (SUD) that have limited utility in terms of infection control. For example, single-use plastic tip guards for nasal atomizers can be replaced with Venturi atomizers cleaned with alcohol to minimize cross-contamination (Otolaryngol Head Neck Surg. 2011;145:411-413). Examples of SUD in OHNS that are eligible for reprocessing include coblation wands, adenoid blades, harmonic scalpels, shavers, and microdissection needles (Otolaryngol Clin North Am. 2019;52:173-183). The use of reusable gowns and drapes as opposed to single-use textiles can significantly reduce solid waste production and may be well-suited to clean-contaminated otolaryngology cases without implants given mixed data on infection outcomes (Ann Plast Surg. 2014;72:S165-169; Am J Surg. 1986;152:505-509; J Am Acad Dermatol. 2011;64:960.e961-920).
  • Considering total intravenous anesthetic instead of anesthetic gases. Despite being released in small quantities, waste anesthetic gases have a large carbon footprint due to their ability to trap heat over a 100-year period. In practical terms, the carbon emissions from one hour of desflurane use in the OR are equivalent to those resulting from driving a car for 230 miles. As such, the environmental impact of volatile anesthetics is significantly higher than that of intravenous, regional, and neuraxial anesthetics (Anesth Analg. 2012;114:1086-1090). Given that total intravenous anesthetic (TIVA) has been shown to improve surgical field visibility, decrease blood loss, and decrease operative times in endoscopic sinus surgery when compared to inhalational anesthetics (Rhinology. 2019;57:402-410), opting for TIVA when medically appropriate can have both patient care and environmental benefits.

Although some healthcare systems have begun to address their carbon footprint through involvement with organizations such as Practice Greenhealth, a nonprofit membership and networking organization for sustainable healthcare, it’s rare for surgeons to be visibly involved despite our role as leaders within the healthcare field. There are many opportunities for advocacy and research within the field of sustainable healthcare, and otolaryngologists in every stage of training and every type of practice are capable of becoming a driving force for positive change. It’s imperative that we each take a step toward sustainability and carbon neutrality for the health of our patients and our planet.