How Can the Environmental Impact of Orthopaedic Surgery Be Measured and Reduced? Using Anterior Cruciate Ligament Reconstruction as a Test Case.

IF 4.2 2区 医学 Q1 ORTHOPEDICS
Nathalia Silva de Souza Lima Cano, Ian D Engler, Rezvan Mohammadiziazi, Federica Geremicca, Dylan Lawson, Nicholas Drain, Volker Musahl, Bryson P Lesniak, Melissa M Bilec
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引用次数: 0

Abstract

Background: The healthcare sector in the United States has increased its greenhouse gas emissions by 6% since 2010 and today has the highest per capita greenhouse gas emissions globally. Assessing the environmental impact and material use through the methods of life cycle assessment (LCA) and material flow analysis (MFA) of healthcare procedures, products, and processes can aid in developing impactful strategies for reductions, yet such assessments have not been performed in orthopaedic surgery. We conducted an LCA and an MFA on an ACL reconstruction (ACLR). The ACLR served as a test case on the assumption that lessons learned would likely prove relevant to other orthopaedic procedures.

Questions/purposes: (1) What are the life cycle environmental impacts of ACLR? (2) What is the material flow and material circularity of ACLR? (3) What potential interventions would best address the life cycle environmental impacts and material circularity of ACLR?

Methods: First, we conducted an LCA according to International Organization for Standardization standards for quantifying a product's environmental impact across its entire life cycle. One result of an LCA is global warming potential measured in carbon dioxide equivalent (CO 2 eq), or carbon footprint. Second, we conducted an MFA of ACLR. Material flow analyses are used to quantify the amount of material in a determined system by tracking the input, usage, and output of materials, allowing for the identification of where materials are consumed inefficiently or lost to the environment. To contextualize the MFA, we calculated the material circularity indicator (MCI) index. This is used to measure how materials are circulating in a system and to evaluate the extent to which materials are recovered, reused, and kept within the economic loop rather than disposed of as waste. These three methods are widely used in other fields, especially engineering, but are more limited in healthcare research. Data collection and observations of ACLRs were made during ACLRs at the University of Pittsburgh Medical Center Bethel Park Surgical Center in Pittsburgh, PA, USA, between 2022 and 2023. Three sessions of data collection and observations were needed due to complexity and scheduling, ranging from understanding the sterilization procedures to weighing individual items. Data encompassing electricity usage; surgical equipment type; the use of heating, ventilation, and air conditioning (HVAC) systems; the production and reuse of reusable instruments and gowns; and the production and disposal of single-use surgical products were collected. Following data collection, we conducted the LCA and the MFA and then calculated the MCI for a representation of a single ACLR. To identify strategies to reduce the environmental impact of ACLR, we modeled 11 possible sustainability interventions developed from prior work and compared those strategies against the impact of the baseline ACLR.

Results: Our results show that the ACLR generated an estimated life cycle greenhouse gas emissions of 47 kg of CO 2 eq, which is analogous to driving a typical gasoline-fueled passenger vehicle for 120 miles. The total mass of all products for one ACLR was estimated at 12.73 kg, including 7.55 kg for disposable materials and 5.19 kg for reusable materials. Concerning material circularity, ACLR had a baseline MCI index of 0.3. Employing LCA for the carbon footprint and the MCI for 11 sustainability interventions indicated the potential to reduce greenhouse gas emissions by up to 42%, along with an increase in circularity (how materials are recovered, reused, and kept within the economic loop rather than disposed of as waste) of up to 0.8 per ACLR. Among the most impactful interventions are the reduction in the utilization of surgical pack products, reutilization of cotton towels and surgical gowns, maximization of energy efficiency, and increasing aluminum and paper recycling.

Conclusion: ACLR has a substantial carbon footprint, which can meaningfully be reduced by creating a minimalist custom pack without material wastage, reusing cotton towels, and maximizing recycling. Combining LCA, MFA, and MCI can provide a thorough assessment of sustainability in orthopaedic surgery.

Clinical relevance: Orthopaedic surgeons and staff can immediately reduce the environmental impact of orthopaedic procedures such as ACLR by opening fewer materials-via making minimalist packs and only opening what is needed in the operating room-and by incorporating more reusable materials such as towels. Larger scale medical center changes, such as implementing recycling programs and installing energy-efficient systems, also can make a meaningful difference in reducing environmental impact.

如何测量和减少骨科手术对环境的影响?以前交叉韧带重建为例。
背景:自2010年以来,美国医疗保健行业的温室气体排放量增加了6%,目前是全球人均温室气体排放量最高的国家。通过医疗程序、产品和流程的生命周期评估(LCA)和物料流分析(MFA)方法来评估环境影响和材料使用,有助于制定有效的减排策略,但此类评估尚未在骨科手术中实施。我们对ACL重建(ACLR)进行了LCA和MFA。ACLR作为一个测试案例,假设所吸取的经验教训可能与其他矫形手术相关。问题/目的:(1)ACLR的生命周期环境影响是什么?(2) ACLR的物料流和物料循环度如何?(3)哪些潜在的干预措施可以最好地解决ACLR的生命周期环境影响和材料循环?方法:首先,我们根据国际标准化组织的标准进行了LCA,以量化产品在整个生命周期中的环境影响。LCA的一个结果是以二氧化碳当量(CO2eq)或碳足迹来衡量的全球变暖潜势。其次,我们进行了ACLR的MFA。物料流分析用于通过跟踪物料的输入、使用和输出来量化确定系统中的物料量,从而确定哪些地方的物料消耗效率低下或丢失在环境中。为了将MFA纳入背景,我们计算了材料循环度指标(MCI)指数。这是用来衡量物料在系统中的循环情况,并评估物料回收、再利用和保持在经济循环中的程度,而不是作为废物处理。这三种方法广泛应用于其他领域,特别是工程领域,但在医疗保健研究中较为有限。在2022年至2023年期间,在美国宾夕法尼亚州匹兹堡市匹兹堡大学医学中心Bethel Park外科中心进行ACLRs期间的数据收集和观察。由于复杂性和日程安排,需要进行三次数据收集和观察,从了解灭菌程序到称重单个项目。包括用电量的数据;手术设备类型;供暖、通风和空调(HVAC)系统的使用;可重复使用的仪器和长袍的生产和再利用;收集一次性手术用品的生产和处置情况。在数据收集之后,我们进行了LCA和MFA,然后计算了单个ACLR表示的MCI。为了确定减少ACLR对环境影响的策略,我们对先前工作中开发的11种可能的可持续性干预措施进行了建模,并将这些策略与基线ACLR的影响进行了比较。结果:我们的研究结果表明,ACLR产生的估计生命周期温室气体排放量为47千克二氧化碳当量,相当于驾驶一辆典型的汽油燃料乘用车行驶120英里。一个ACLR的所有产品的总质量估计为12.73千克,其中一次性材料为7.55千克,可重复使用材料为5.19千克。关于材料循环度,ACLR的基线MCI指数为0.3。将LCA用于碳足迹,将MCI用于11项可持续性干预措施,表明有可能减少高达42%的温室气体排放,同时将循环度(材料如何被回收、再利用并保持在经济循环中,而不是作为废物处理)提高至每ACLR 0.8。其中最有效的干预措施是减少手术包产品的使用,棉巾和手术服的再利用,最大限度地提高能源效率,并增加铝和纸张的回收利用。结论:ACLR有大量的碳足迹,可以通过创建一个没有材料浪费的极简定制包装,重复使用棉毛巾和最大化回收来显著减少碳足迹。结合LCA、MFA和MCI可以对骨科手术的可持续性进行全面评估。临床意义:整形外科医生和工作人员可以通过使用更少的材料(通过制作极简的包装,只打开手术室需要的材料)和使用更多可重复使用的材料(如毛巾),立即减少ACLR等整形外科手术对环境的影响。大型医疗中心的改变,如实施回收计划和安装节能系统,也可以在减少对环境的影响方面产生有意义的影响。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
7.00
自引率
11.90%
发文量
722
审稿时长
2.5 months
期刊介绍: Clinical Orthopaedics and Related Research® is a leading peer-reviewed journal devoted to the dissemination of new and important orthopaedic knowledge. CORR® brings readers the latest clinical and basic research, along with columns, commentaries, and interviews with authors.
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