BLOG: Going green in the surgical suite

ByJohn A. Hovanesian, MD, FACS

In my operating room, we often joke that we are “going green” on those happy occasions when we don’t need to open a product that we thought we’d need for surgery. It's funny to us because we've become so numbed to throwing away bags and bags of trash generated by surgery each day.

A recent U.K. study showed that a single 5-minute cataract surgery generates as much carbon waste as a single person does in more than 1 week of ordinary living. If we add up all the carbon output from all the cataract surgeries performed in 1 year in the U.S. — approximately 3.3 million — as much carbon would be generated as a single human would generate in 66,000 years.

To be sure, part of this is transportation cost for people and goods moving from place to place, and there are indeed efficiencies to be found here. But an even greater contributor is the packaging of single-use supplies that we consume and then throw away after just one procedure.

Does every patient need to be draped from head to toe to do cataract surgery? Does every bottle of balanced salt solution need to be incinerated with medical waste simply because a tiny portion of epinephrine was injected into the bottle, less stimulant than you would find in a bottle of Visine? Does every phaco cassette have to be thrown away rather than sterilized and reused as is still done in other countries? All of these examples, and many more, are dictated by laws, local regulations and/or manufacturers’ practices.

But laws, local regulations and company practices can all change in response to physician demand.

Let’s start with companies. All the major manufacturers of phaco equipment now recognize the importance of containing costs for monofocal IOLs and supplies used to implant them. If we additionally admonish companies to reduce packaging and create reusable tubing, as they all used to, won’t they all at some point fall in line behind this common-sense approach? I would love to see “the greenest cataract surgery system" touted in marketing materials for phaco equipment one day.

Federal and state regulators and hospital policymakers currently see little reason to stray from policies of “use once and discard" that generate so much waste. Companies profit by selling more product this way. But well-done studies in first-rate hospitals have shown repeatedly that providing high-quality care does not require the generation of so much waste.

Now is the time for physicians to make regulators aware of the need to cut waste and costs associated with single-use surgical supplies. Otherwise, as consumption of medical care continues to rise, so will the cost of disposing of these items, so will the environmental impact of their use and so will our responsibility as physicians for that environmental impact if we fail to speak up now.

Disclosure: No products or companies that would require financial disclosure are mentioned in this article.