Anesthesia, Sterility Measures Contribute To Large Carbon Footprint of Health Care Systems Interview with:
 <a href="">“surgery”</a> by <i> <a href="">Army Medicine</a> </i> is licensed under <a href=""> CC BY 2.0</a>Andrea MacNeill MD MSc FRCSC

Surgical Oncologist & General Surgeon
University of British Columbia
Vancouver General Hospital
BC Cancer Agency What is the background for this study?

Response: Climate change is one of the most pressing public health issues of the present era, responsible for 140,000 deaths annually.  Somewhat paradoxically, the health sector itself has a considerable carbon footprint, as well as other detrimental environmental impacts.  Within the health sector, operating rooms are known to be one of the most resource-intensive areas and have thus been identified as a strategic target for emissions reductions. What are the main findings?

Response: This study was the first to estimate the carbon footprint of surgery, in order to situate this within a broader health care context.  At the three hospitals studied, operating rooms emitted between 3000 and 5000 tonnes of CO2 equivalents annually, or 188 tonnes of CO2 per OR per year.

The main findings, however, were with respect to the contributors to this footprint.  Anesthetic gases are potent greenhouse gases, with global warming potentials between 130 and 2450 times that of CO2.  This study provided a stark demonstration of the impact of one of these gases – desflurane – on operating room emissions.  Desflurane was the preferred anesthetic gas at the two North American hospitals whereas it was not used at all in the UK hospital and the difference in anesthetic carbon footprint was 10-fold.  Interestingly, desflurane is also the most expensive anesthetic gas so defaulting to a different agent entails cost as well as carbon savings.  We looked at energy consumption in the operating room and showed that HVAC (heating, ventilation and air conditioning) requirements are responsible for 90-99% of all OR energy use because of how stringently this space must be conditioned in order to maintain sterility.  Many hospitals maintain these ventilation standards 24/7, even when the operating rooms are not in use.  Scaling back ventilation after hours when there are no surgeries happening can result in significant energy savings, which of course is also cost-saving. What should clinicians and patients take away from your report?

Response: Health care isn’t the first thing that comes to mind when discussing climate change and pollution, but in fact it’s a big player.  We would like people within the health sector to appreciate the magnitude of the problem and the discordance with our moral imperative to “do no harm”, and to be encouraged by the easy wins that this study demonstrates in terms of emissions reduction strategies.  We would encourage health professionals in other clinical arenas to take advantage of the methodologies we derived to investigate their own carbon footprints, and to become public health advocates by acknowledging the inextricable links between health and the environment.  The health sector should be a leader in climate change mitigation.  We have an obligation to protect the health of current and future generations and the ecosystems that sustain them. What recommendations do you have for future research as a result of this study?

Response: We would like to replicate this study at more institutions to validate the results and identify more actionable areas for emissions reduction.  We also need life cycle assessments (LCAs) of medical products and processes in order to determine best practices in terms of environmental performance.  These have been carried out for a number of surgical and anesthetic areas, led primarily by Jodi Sherman at Yale University and Cassie Thiel at NYU, but there is a pressing need for more data to guide environmentally-preferable decision making.  We also need better instruments to measure the environmental impacts of health care on a system-wide or national level, as there are unique features to the health care footprint such as pharmaceuticals and biohazards.

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Andrea J MacNeill, Robert Lillywhite, Carl J Brown. The impact of surgery on global climate: a carbon footprinting study of operating theatres in three health systems. The Lancet Planetary Health, 2017; 1 (9): e381 DOI: 10.1016/S2542-5196(17)30162-6

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions. 






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