Building Technologies

‘Green Surgery Model’ Reduces Hospital Environment Footprint

06 December 2017

The waste generation from just one cataract surgery in the United States compared to the waste generation from 93 cataract surgeries in India. Source: Cassandra Thiel, PhDThe waste generation from just one cataract surgery in the United States compared to the waste generation from 93 cataract surgeries in India. Source: Cassandra Thiel, PhD

Transportation and fossil fuel industries typically come to mind as major sources of pollution. Less noticed is the contribution of the healthcare industry. The healthcare industry emits nearly 10 percent of greenhouse gases and other air pollutants in the United States and 3 percent in the United Kingdom.

New research by faculty at NYU School of Medicine finds that a healthcare center in India is the model for environmental sustainability. Combining several techniques, Aravind Eye Care System in the south of India emitted 96 percent less carbon than the U.K. while producing comparable or better health outcomes for cataract surgery, one of the world’s most common surgical procedures.

Cataracts are the leading cause of blindness and visual impairment worldwide, so reducing the footprint of the procedure could make a significant difference, according to the researchers.

"Our overuse of disposable materials in surgery is unsustainable," says study leader Cassandra Thiel, Ph.D., assistant professor in the Department of Population Health at NYU School of Medicine. "Ophthalmologists and other medical specialists should seek ways to reduce material use and emissions in medical procedures. This center in India can serve as a model."

From November 2014 through February 2015, the researchers analyzed surgical materials, energy and waste from cataract surgery, calculating their greenhouse gas emissions, as well as emissions related to ozone depletion, water eutrophication, toxicity and air pollutants. For the same procedure, the authors found that Aravind emitted 4 percent of the emissions of a comparable operation in the U.K.

Specifically, Aravind’s emissions per surgery amounted to 6 kilograms of carbon dioxide equivalent compared to the 160 kilograms of carbon dioxide equivalent in the U.K. This is like driving 14 miles versus 391 miles. These proportions would be similar, if not larger, in the U.S.

Practices at Aravind that made the most difference were shorter surgery durations; better re-use of surgical gowns, caps, booties and blankets; multi-use pharmaceuticals; and more efficient sterilization of stainless steel instruments so they can be reused the same day.

Aravind’s advances come as India seeks to end preventable blindness, which is a goal of the World Health Organization Vision 2020 initiative, by doubling its current cataract surgical rate.

If India’s ophthalmologists used the U.K.’s current surgical methods to achieve its goal, it would emit the same greenhouse gases at 250,000 passenger vehicles’ yearly mileage, according to the researchers. But if India employed Aravind’s approach, it would only emit the same greenhouse gases as 9,000 passenger vehicles.

"As healthcare systems and professionals worldwide become more aware of and concerned for the public health implications of climate change and excessive resource use, efficient care delivery models must be better understood and promoted," says Dr. Thiel.

"Aravind's model for surgery — its use of reusable instruments, energy-efficient appliances, and air handling systems, and investment in low-carbon energy sources — serves as an example of more sustainable, efficient cataract surgery," adds senior author Joel S. Schuman, MD, chair of the Department of Ophthalmology at NYU School of Medicine.

The paper on this research was published in Journal of Cataract and Refractive Surgery.

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