• Andy Y Wang, Tameem Ahsan, Jacob J Kosarchuk, Penny Liu, Ron I Riesenburger, and James Kryzanski.
• Department of Neurosurgery, Tufts Medical Center, Boston, Massachusetts, USA.
• World Neurosurg. 2022 Jul 1; 163: e199-e206.

BackgroundThe U.S. health care sector produces approximately 10% of national greenhouse gas emissions, paradoxically harming human health. Neurosurgery is a resource-intensive specialty that likely contributes significantly, yet literature assessing this impact is absent. We investigate the difference in carbon emissions between spinal versus general anesthesia in lumbar spine surgery.MethodsA total of 100 patients underwent a single-level transforaminal lumbar interbody fusion (TLIF) from a single surgeon; 50 received spinal anesthesia and 50 received general anesthesia. Data were extracted from patient records. Amounts of anesthetics were calculated from intraoperative records and converted to carbon dioxide equivalents (CO2e).ResultsThe median CO2e for general anesthesia was 4725 g versus 70 g for spinal anesthesia (P = 7.07e-18). The mean CO2e for general anesthesia was 22,707 g versus 63 g for spinal anesthesia. Desflurane use led to outsized carbon emissions. Carbon footprint comparisons are made with familiar units such as miles driven by a car, and are provided for a single TLIF, 50 TLIFs (single surgeon's cases in a year), and 488,000 TLIFs (annual spinal fusions in the United States).ConclusionThis is one of the first known comparative carbon footprint studies performed in neurosurgical literature. We highlight the dramatic carbon footprint reduction associated with using spinal anesthesia and reflect a single neurosurgeon's change in practice from using only general anesthesia to incorporating the use of spinal anesthesia. Within general anesthesia patients, desflurane use was particularly harmful to the environment. We hope that our study will pave the way toward future research aimed at uncovering and reducing neurosurgery's environmental impact.Copyright © 2022 Elsevier Inc. All rights reserved.

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