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Patient Safety and Quality Improvement

(115) Cost and Carbon Footprint of Tonsillectomies at High-Income Tertiary Center

Monday, October 2, 2023
2:45 PM – 3:45 PM East Coast USA Time

    Presenting Author(s)

  • Gaelen B. Stanford-Moore, MD

    Resident Physician
    University of California - San Francisco
    San Francisco, CA, USA

    • Senior Author(s)

  • Gaelen B. Stanford-Moore, MD

    Resident Physician
    University of California - San Francisco
    San Francisco, CA, USA

    • Co-Author(s)

  • GC

    Gabrielle Cahill, MD

    University of California Los Angeles, Department of Otolaryngology/Head and Neck Surgery, United States

  • Omeed Miraftab-Salo, BS

    Medical Student
    University of California, San Francisco School of Medicine
    San Francisco, California, United States

  • AR

    Allison Rollins, MD

    University of Pittsburgh, Department of Otolaryngology/Head and Neck Surgery, United States

Disclosure(s):
Omeed Miraftab-Salo, BS: No relevant relationships to disclose.


Introduction: Climate change directly impacts health and safety. Healthcare services are responsible for 8% of greenhouse gas emissions in the US, with operating rooms contributing up to 70% of all hospital waste. This is the first study to explore the cost and carbon footprint of all opened, used and unused supplies during a standard tonsillectomy in a high-income tertiary care center.

Methods: Prospective audit of all waste generated during a standard tonsillectomy between January 2023 and June 2023. Pediatric tonsillectomy with monopolar cautery or cold steel technique were included. A member of the team was present in the operating room to document supplies. All waste was weighed by type: landfill, recycling, biohazard. Kilograms of carbon dioxide equivalent were calculated using an estimate developed by the Yale Center for Climate Change based on hospital-provided costs of individual supplies.

Results: 19 tonsillectomies met criteria for inclusion, nine cold steel and 10 monopolar cautery. No differences were found in average length of surgery, type and weight of waste generated, cost nor carbon dioxide equivalent between the two techniques. Overall, 47% of supplies opened were not used. The overall cost of surgical supplies averaged $320, while unused supplies averaged $39. The most commonly opened but unused supplies were sterile blue towels, tonsil sponges and x-ray opaque sponges (74%, 63%, 79% unused, respectively). The overall kilogram of carbon dioxide equivalents was 78, with a 12.9% contribution from unused supplies and equipment. 80% of all supplies opened were single-use disposable items, primarily made of plastic.

Conclusions: There was no significant difference in cost and carbon footprint between monopolar cautery and cold steel techniques, however, a significant portion of supplies opened were left unused and discarded. Surgeons should be aware of waste generated by their procedures. Updating preference cards is one simple step to decrease wasted supplies. Further research should characterize how operating room waste differs in the same procedure in different settings.