• Cassandra L Thiel, Noe C Woods, and Melissa M Bilec.
• Cassandra L. Thiel is with the Department of Population Health, New York University Langone Medical Center, New York, NY. Noe C. Woods is with the Department of Obstetrics and Gynecology, University of Pittsburgh Medical Center, Pittsburgh, PA. Melissa M. Bilec is with the Department of Civil and Environmental Engineering, University of Pittsburgh.
• Am J Public Health. 2018 Apr 1; 108 (S2): S158-S164.

ObjectivesTo determine the carbon footprint of various sustainability interventions used for laparoscopic hysterectomy.MethodsWe designed interventions for laparoscopic hysterectomy from approaches that sustainable health care organizations advocate. We used a hybrid environmental life cycle assessment framework to estimate greenhouse gas emissions from the proposed interventions. We conducted the study from September 2015 to December 2016 at the University of Pittsburgh (Pittsburgh, Pennsylvania).ResultsThe largest carbon footprint savings came from selecting specific anesthetic gases and minimizing the materials used in surgery. Energy-related interventions resulted in a 10% reduction in carbon footprint per case but would result in larger savings for the whole facility. Commonly implemented approaches, such as recycling surgical waste, resulted in less than a 5% reduction in greenhouse gases.ConclusionsTo reduce the environmental emissions of surgeries, health care providers need to implement a combination of approaches, including minimizing materials, moving away from certain heat-trapping anesthetic gases, maximizing instrument reuse or single-use device reprocessing, and reducing off-hour energy use in the operating room. These strategies can reduce the carbon footprint of an average laparoscopic hysterectomy by up to 80%. Recycling alone does very little to reduce environmental footprint. Public Health Implications. Health care services are a major source of environmental emissions and reducing their carbon footprint would improve environmental and human health. Facilities seeking to reduce environmental footprint should take a comprehensive systems approach to find safe and effective interventions and should identify and address policy barriers to implementing more sustainable practices.

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