I distinctly remember the first time I observed an eye surgery at Aravind Eye Hospital in Madurai in India, where the majority of surgeries are performed for free or at reduced cost to patients, so a premium is placed on efficiency. The surgeon whirred through the case, with the knowledge that she had dozens more surgeries to do that day — nearly 500,000 eye surgeries per year are completed there, making it one of the largest eye care facilities in the world.
But I was less interested in each surgery than the aftermath, where I got to see firsthand the efficiency they are known for. Nurses and custodial staff cleared the operating table and placed waste into neatly labeled containers: one each for biohazard, incineration, and recycling. There was little waste per surgery; the majority of supplies were recycled or sent to be sterilized so that they could be reused. I was stunned to see how little waste was produced per procedure. But a couple of months later, I observed the same types of surgeries at a mid-sized community hospital in the U.S. Here, there was no bin for recycling, and the majority of supplies were single-use and disposable. I knew there was a way to be better, so I started studying how to make health care more efficient. I have long believed that increased efficiency could enable the health care system to reach more people, and I was intrigued by the environmental and economic costs of waste and ways to decrease these costs.
Not surprisingly, I found that the amount of waste per surgery produced at the U.S. hospital I looked at was 3.76 times greater than the amount of waste produced for the same type of surgery at Aravind, despite the two hospitals having similar intraoperative and postoperative complication rates. My data further showed that a significant portion of the waste produced at Aravind was recycled, while none of the waste produced at the American hospital was.
“Every dollar we save by safely reusing surgical materials can be applied toward treating more patients,” a surgeon at Aravind explained to me. Meanwhile in America, a study found that two million pounds of unused surgical supplies, worth $15 million, are discarded annually.
Beyond financial ramifications, procedural waste also has a major, under-discussed impact on the environment. The American health care sector is responsible for 8-10% of the country’s greenhouse gas emissions, and procedural waste contributes to these emissions.
As I have seen at the community hospital in the U.S. where I studied eye surgery, and at several other hospitals where I have trained clinically, very little procedural waste in this country is recycled. The vast majority is incinerated, which releases a significant amount of greenhouse gases into the environment. Unlike in India, where resources are relatively scarce and must be reused, in the U.S. the abundance of surgical supplies has made us collectively complacent about this subject.
In the U.S., there are stringent regulations governing the production and disposal of procedural waste. For example, I found through my research that the FDA promotes the use of single-use drug vials and procedural supplies. Defenders of American regulators’ attitudes toward procedural waste may intuitively argue that single-use procedural supplies decrease the risk of infection and complications, but my research and others’ work demonstrate that this defense is often not supported by objective measures.
But climate change is an impending crisis, and each of us must examine our environmental impact and seek ways to decrease it. My research was merely a tentative first step toward decreasing procedural waste — my coauthors and I quantified waste per different types of eye surgeries. By comparing waste produced at Aravind Eye Hospital and at the sample American hospital, we demonstrated that it is possible to decrease the waste produced per surgery without affecting patient outcomes.
The body of literature on procedural waste is small, but it is growing. We are collectively increasing our awareness of health care’s impact on the environment, and single-institution and small pilot projects are beginning to seek ways to decrease the quantity of waste produced per surgery. We are a long way from reaching peak conscious efficiency, but we are slowly moving in that direction.
Individual proceduralists can assist with this effort by not opening supplies unless deemed necessary for a procedure. Support staff can seek to recycle certain types of waste instead of reflexively depositing all waste in the same bin. Administrators and policymakers can shift the paradigm toward seeking ways to decrease waste produced per procedure, with the knowledge that doing so will decrease the economic and environmental impact of procedures. If we work together to decrease procedural waste, all of us — including the planet — will realize the benefits.
Where else in the hospital do you see opportunities to save money and the environment? Share your ideas in the comments.
Sathvik Namburar, originally from Duluth, GA and a graduate of Johns Hopkins University, is currently a medical student at Dartmouth College in Hanover, NH. His writing has been published in USA Today, Boston Globe, and Baltimore Sun, among other publications. His interests include public health policy and health care equity, as well as global health. He is a 2021–2022 Doximity Op-Med Fellow.
Illustration Collage by Jennifer Bogartz / Anastasia Usenko / Elena Bordyuzhova / gettyimages