Technology
the evidence and are often based on anecdotes and outdated practices. For example, in their Global Guidelines for the Prevention of Surgical Site Infection, the World Health Organization states that reusable drapes and gowns do not pose any additional risk of harm over disposable products;9
reusable products offer
hospitals a safe and waste-reducing alternative to disposable ones. Reusable surgical gowns, for example, have repeatedly been shown to be well-accepted by staff, comfortable, and sustainable.10 In the US, a multi-centre study looked at the impact of switching generic disposable items such as basins, gowns, drapes, and Mayo stand covers to reusable alternatives. The researchers found that this switch enabled theatres to safely reduce their total waste by an average of 65%, reducing landfill and carbon emissions and saving each hospital over $13,000 per year.11 Closer to home, grassroots initiatives
have successfully introduced reusables into local protocols and supply chains to cut environmental and financial waste. In 2022, a team from Leeds Teaching Hospitals NHS Trust ran a project to reduce the carbon footprint of laparoscopic appendectomy. They did this by implementing several new measures, including eliminating single-use gowns and drapes and rationalising their equipment tray.12
In an award-
winning initiative, the team reduced their carbon footprint, lowered waste, and cut the cost of each laparoscopic appendectomy performed in their region.
Opened but never used Reducing the use of disposable supplies is impactful and achievable. However, the amount of waste generated isn’t explained only by the use of single-use equipment but also by the routine practice of opening them before they are needed.
In 2015, a Johns Hopkins team reported that major hospitals across the US collectively throw away at least $15 million a year in unused surgical supplies — all brand new, in date, but routinely discarded along with soiled material at the end of each procedure.13
The authors found that this often stemmed from the routine
How much does it cost? Do you know the price of the equipment you routinely use in theatre? If not, you’re in the majority. A common finding across this kind of research is that the end-users of surgical supplies generally don’t have an accurate idea of what they cost, which has repeatedly been shown to drive waste generation and the associated costs. One study found that orthopaedic surgeons could accurately estimate the cost of the implants they used just 21% of the time.15
Others produced similar findings in
practice of bundling materials together in disposable packages designed to streamline convenience and efficiency; even if all items in the pack remain unused, once open, everything is discarded. This pattern is typical across research and countries. A neurosurgical team in the Netherlands measured the direct cost of single- use items that were opened but not used in neurointervention, revealing these cost them an average of €515.09 per procedure.14 For some procedures, such as aneurysmal coiling, this was as high as €1061.55. The authors explained that this likely reflects the tendency to anticipate emergencies in neurosurgery, concluding that responsible use of disposable material can be achieved by educating surgeons and nurses on costs, including the use of cheaper alternatives and reusable supplies where available. But why are we doing this? Opening something only to throw it away unused is counterintuitive and counterproductive. What can we do to make more informed, sustainable decisions? Across specialties and studies, one recommendation repeatedly emerges for reducing waste in surgical care: knowledge is the key.
general surgery, ENT, and urology, with clinicians’ estimates ranging from 14%−25% accuracy when asked about the cost of the materials they routinely use.16 As well as waste, this lack of knowledge
and transparency around price creates large variations in the supply costs for a procedure. A study of hand surgeons found a four-fold difference in the supply costs between 35 surgeons performing the same three procedures.17
Interestingly, differences in the
use of low-cost supplies such as drapes, towels, and gauze contributed most to the variations in cost and carbon.
Solutions to increase transparency Despite the cost and scale of waste inherent in theatres, one positive message emerges. When staff are given the knowledge and resources to make sustainable decisions, these are generally the ones we will make. Research has demonstrated consistent
savings and waste reduction patterns in studies where teams are educated to select less expensive supplies.18,19
The Urology
Department at Stanford University, for example, demonstrated that adjusting surgeons’ preference cards (lists the items each surgeon requires for each procedure) to remove unused disposable supplies resulted in a 92% reduction in waste and a potential cost saving of $9880 per theatre.20 The ability to rationalise these choices hinges on the end-users (surgeons and operating theatre teams) being able to transparently see their procedure-specific supplies in the context of their teams and workflows. When given the information to prepare optimally, theatre teams can make transparent and informed decisions about materials and resource allocation. In the
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