摘要：Objectives. To determine the carbon footprint of various sustainability interventions used for laparoscopic hysterectomy. Methods. We designed interventions for laparoscopic hysterectomy from approaches that sustainable health care organizations advocate. We used a hybrid environmental life cycle assessment framework to estimate greenhouse gas emissions from the proposed interventions. We conducted the study from September 2015 to December 2016 at the University of Pittsburgh (Pittsburgh, Pennsylvania). Results. The largest carbon footprint savings came from selecting specific anesthetic gases and minimizing the materials used in surgery. Energy-related interventions resulted in a 10% reduction in carbon footprint per case but would result in larger savings for the whole facility. Commonly implemented approaches, such as recycling surgical waste, resulted in less than a 5% reduction in greenhouse gases. Conclusions. To reduce the environmental emissions of surgeries, health care providers need to implement a combination of approaches, including minimizing materials, moving away from certain heat-trapping anesthetic gases, maximizing instrument reuse or single-use device reprocessing, and reducing off-hour energy use in the operating room. These strategies can reduce the carbon footprint of an average laparoscopic hysterectomy by up to 80%. Recycling alone does very little to reduce environmental footprint. Public Health Implications. Health care services are a major source of environmental emissions and reducing their carbon footprint would improve environmental and human health. Facilities seeking to reduce environmental footprint should take a comprehensive systems approach to find safe and effective interventions and should identify and address policy barriers to implementing more sustainable practices. Activities in the health care sector emit 10% of the United States’ total greenhouse gases (GHGs), 1,2 thus adversely affecting human health. Yet environmental sustainability in the health care sector remains understudied. 3–8 Previous research identifies the operating room (OR) as a major source of spending and waste generation in a medical facility, 9–11 accounting for 650 to 1200 kilograms of medical waste per day and more than 3 million kilograms of GHG emissions per hospital annually. 12 We examined the efficacy of interventions designed to reduce GHG emissions in the OR for 1 of the most common major surgeries for women, laparoscopic hysterectomy. More than one third of American women undergo a hysterectomy by aged 60 years. 13 Minimally invasive laparoscopic surgeries are increasing in use worldwide, and laparoscopic techniques are commonly employed in thoracic and orthopedic procedures. Using the baseline emissions from our 2014 study of hysterectomy, 11 we calculated the GHGs of interventions for laparoscopic hysterectomy to determine high-value methods to reduce GHGs in the OR. Climate change will have serious repercussions on public health without significant leadership and action. Considering the footprint of health care in the United States, the medical field requires more data and quantitative guidance on implementation strategies. 2,14–18 Organizations that support sustainability awareness and action in health care facilities present members with an array of greening strategies, ranging from increasing recycling rates, using less water and energy, and increasing single-use device (SUD) reprocessing (whereby SUDs are cleaned and sterilized by a third-party processor and reused in the OR). The relative quantitative effects of these strategies are unknown, and for resource-constrained health care facilities, achieving their GHG and climate-related goals requires targeting the most efficacious strategies. Some studies have begun to evaluate the environmental footprint of the materials and energy used in surgery and the OR, 5,8,19–22 but few, if any, have determined which sustainability interventions have the largest impact on the surgery’s carbon footprint. Our goals were to identify and model the impact of sustainability interventions in the OR for laparoscopic hysterectomy. We used data from a previous scope 3, hybrid life cycle assessment environmental impact study of hysterectomy at Magee-Womens Hospital of the University of Pittsburgh Medical Center (UPMC). 11 Magee performs about 1600 hysterectomies annually, more than half of which are done laparoscopically.
