Abstract
It is estimated that a quarter to half of all hospital waste is produced in the operating room. Recycling of surgical waste in the perioperative setting is largely underutilized, despite the fact that many of the materials being discarded can be potentially recycled safely and easily. Given this mounting waste production, recycling programs have become increasingly popular. Therefore, the primary objective of this study is assess the effect of these recent eco-friendly polices by determining the amount of waste and recycling produced in the pre-operative and operative time period for several orthopaedic subspecialties.
Surgical cases were prospectively chosen and assigned to an orthopaedic subspecialty category, which included trauma, arthroplasty, sports, foot and ankle, upper extremity, and paediatrics. The preoperative phase began with the opening of the surgical case carts and concluded with the end of skin preparation. The intraoperative period began after skin preparation was complete, and concluded after the operating room was cleaned. At the end of the preoperative period all surgical waste was weighed and divided into recyclables and non-recyclables. Following the intraoperative period, surgical waste was divided into recyclables, non-recyclables, linens, and biohazardous waste streams. All bags were weighed in a standardized fashion using a portable hand held scale. The primary outcome of interest was the amount of recyclable waste produced per case. Secondary outcomes included the amount of nonrecyclable, biohazardous and total waste produced during the same time intervals. Statistical analysis was then completed using (ANOVA) to detect differences between specialties.
This study included 55 procedures collected over a 1-month period at two hospitals from October 2017 to November 2017. A total of 341 kg of waste was collected with a mean mass of 6.2 kg per case. In terms of primary outcomes, arthroplasty surgery produced a significantly greater amount of recyclable waste per case in the preoperative (2327.9 g)and intraoperative (938.6 g)period. It also produced the greatest amount of total recyclable waste per case, resulting in a significantly greater ratio of waste recycling per case then nearly all other specialties in the preoperative (86.2%) and intraoperative period (14.5%). In terms of secondary outcomes, arthroplasty surgery similarly produced a significantly greater amount of nonrecyclable waste per case then all other specialties (5823.6 g), the majority of which was produced during the intraoperative period (5512.9 g). Arthroplasty surgery also produced a significantly greater amount of biohazardous waste then all other specialties (409.3 g). The majority of surgical waste was produced in the intraoperative period compared to the preoperative period. In the preoperative period an average of 74.4% of waste was recyclable, compared to 7.6% of waste produced during the intraoperative period. In total, the average amount of waste recycled per case was 25.6%. Biohazardous waste only constituted 1.8% of the total waste mass.
Orthopaedic surgery is a significant source of waste production in our hospital system. Among orthopaedic subspecialties, arthroplasty is one of the largest waste producers, but also has the highest potential for recycling of materials. Effective OR recycling programs can significantly reduce our ecological footprint by diverting waste from landfills. In particular, the preoperative period has significant potential for landfill diversion as our study showed that nearly three quarters of all waste in this period can be effectively recycled.
