O3256: Dissecting Waste and Emissions in Surgical Supracondylar Humerus Fractures

Background: Supracondylar humerus (SCH) fractures are the most common elbow fracture diagnosed in children. Surgical charges for SCH fractures can total upwards of $17,000 per case. Such costs fail to account for significant unmeasured, overlooked costs to our natural environment. Recent studies have highlighted opportunities to reduce unnecessary waste in SCH treatment with resultant benefits to patient safety and outcomes including reduced anesthesia time. This study aims to quantify the environmental impact of closed reduction and percutaneous pinning (CRPP) of SCH fractures using life cycle assessment (LCA) and further aims to identify opportunities for environmental harm reduction and resource stewardship across varied settings.

Methods: A waste audit was conducted for consecutive SCH pinning cases. Waste attributable to items listed on the preference card was calculated. Additional waste attributable to intraoperative requests, anesthesia and other streams was considered separately. Each item and its component materials were weighed individually. Material specifications were extracted from manufacturer technical data sheets and the contributions of each item were calculated and analyzed using the Ecoinvent 3 database in Simapro 9.6.01 software with the TRACI 2.1 V1.09 impact assessment tool.

Results: CRPP of a SCH fracture generated 6.85kg of landfill waste and the equivalent of 28.65 kg of CO2 emissions. Disposable medical products, packaging and PPE amounted to 3.6kg of mixed landfill waste, equivalent to 18.2 kgCO2eq whereas reusable tools and equipment measured 4.2 kg, requiring 8.0 kWh of energy to be sterilized. From items on the doctor preference card which are opened for every SCH case, the greatest environmental harm was generated by drapes and blue towels across 8 of 10 impact categories (global warming, smog, acidification, eutrophication, carcinogenics, ecotoxicity, respiratory effects, fossil fuel depletion). When modeling a semi-sterile technique, 15 kgCO2eq would be saved per case. Over the 411 SCH CRPPs performed at our institution annually, this would save 6,165 kgCO2eq, equivalent to 6,848 lbs of coal burned.

Conclusion: Unnecessary surgical waste does not improve patient outcomes; rather it contributes to cost, environmental harm and declining health outcomes amongst pediatric patients at large. In CRPP of SCH fractures-a streamlined, common procedure-disposable drapes, gowns and packaging emerge as serious offenders. Surgeons should be aware of specific, actionable opportunities for waste and emissions reduction. Industry stakeholders should recognize and answer for their offending contributions. Scrutinizing preference cards and procedure packs for unnecessary contents can further enable thoughtful stewardship of valuable medical resources.