O2086: Climate Change and the Operating Room: Perceptions of Orthopaedic Surgeons on Environmental Sustainability

Background: Climate change presents a significant global health threat, with over 250,000 deaths annually attributed to its negative downstream environmental effects by the World Health Organization. The healthcare sector, notably the operating room (OR), contributes substantially to our carbon footprint and is responsible for close to 10% of greenhouse gas emissions in the United States. Orthopaedic surgery generates a disproportionate amount of waste compared to other specialties. Few studies have explored perspectives on OR sustainability among medical providers. In order to better characterize current OR practices and barriers to sustainability in orthopaedic surgery, we surveyed orthopaedic attendings and trainees in the United States about their attitudes towards this important topic.

Methods: Drawing on a previous survey conducted among otolaryngologists, a 36-question survey focused on several domains, including beliefs, OR sustainability attitudes, practice patterns, and education, was distributed to five orthopaedic surgery programs in the U.S. Quantitative descriptive analyses were conducted using R. χ2 tests were utilized to assess for differences in responses between age group, educational level, fellowship type, and region of practice.

Results: There was a total of 92 respondents to the survey, the demographics of which are shown in Table 1. 98.9% of participants reported believing that climate change is occurring. However, the percentage of participants that believed that human intervention can have a meaningful effect on the course of climate change (64.4%) and that OR waste significantly contributes to the climate crisis (46.0%) were lower. There were no significant differences in responses based on training level, fellowship type, or region of practice.

98.9% of respondents reported that significant improvements could be made at their institution in terms of OR waste and environmentally friendly practices. 87.3% of attending and residents believed that OR overage, including energy and water utilization, can be minimized or improved. They estimated that on average, 31% [IQR 20%-40%] of single-use, sterile supplies opened for surgery were unused at the end of a case.

Only 24.2% of respondents expressed satisfaction with the environmental practices at their institution. Lack of incentive (79%), cost (62.9%), and lack of information/knowledge (62.9%) were identified as the largest barriers to improving OR sustainability. 83.3% of respondents believed that medical trainees should be provided with formal teaching regarding environmental sustainability and healthcare, yet most (66.2%) attendings and residents reported that they do not teach trainees who rotate with/shadow them about sustainability in healthcare.

Conclusion: A majority of orthopaedic attendings and trainees believe in climate change and feel that OR sustainability efforts can be improved at their institution. There are clear opportunities to reduce waste and increase recycling, but high costs and a lack of knowledge/education pose significant barriers. Implementing a discussion of climate change into the medical school and residency curriculum is needed moving forward.