Faculty Bibliography

STUDY OBJECTIVE/OBJECTIVE:To quantify and characterize waste generated in robotic gynecologic surgery and assess its environmental impact, with the goal of identifying strategies to reduce waste and improve sustainability. DESIGN/METHODS:Waste audit and life cycle impact assessment of robotic gynecologic surgery. SETTING/METHODS:Single academic institution. PATIENTS/METHODS:Twenty robotic gynecologic surgery cases, including hysterectomies (n = 10), myomectomies (n = 6), and tubal, ovarian, or endometriosis surgeries (n = 4). INTERVENTIONS/METHODS:A detailed waste audit of all surgical waste to categorize materials into municipal solid waste (MSW) and regulated medical waste (RMW), allowing for subsequent life cycle impact assessment. MEASUREMENTS AND MAIN RESULTS/RESULTS:e (SD 0.27) per minute of operative time, with shorter surgeries producing the most emissions per minute. Cotton products contributed up to almost one-third of an impact category despite accounting for 5% of the total waste by weight. CONCLUSION/CONCLUSIONS:Opportunities to reduce the environmental impact of robotic gynecologic surgeries include reorganizing surgical kits to avoid the unnecessary opening of commonly unused items, increasing reprocessing of single-use devices, properly sorting recyclable plastics and paper products, appropriately using RMW streams, considering alternative surgical modalities for less complex cases, and exploring reusable or more environmentally-friendly alternatives to cotton and spunbond-meltblown-spunbond polypropylene products.

In LA County, contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus require 7.3 million gowns annually generating 506 tons of plastic waste and 1.73 million kilograms of carbon dioxide equivalents, which cause the loss of 4.07 disability-adjusted life-years. Unintended consequences of gown use necessitates exploration of infection prevention alternatives.

OBJECTIVE:To assess the environmental impact of magnetic resonance (MR) and computed tomography (CT) imaging using life cycle assessment (LCA), focusing on energy use, resource consumption, and emissions. METHODS:This ISO 14040-guided LCA-based study focused on MRI and CT services, including the production and use of three MRI and four CT scanners, at a quaternary care 800-bed academic medical center in the Southeastern USA over a one-year period. Data were collected through direct observation, record review, staff interviews, and energy metering. Environmental impacts were assessed using SimaPro 9.3.0.2 and the Ecoinvent v3.8 database. RESULTS:MRI and CT services at this site generate an estimated 221 and 108 tons of CO2e per year, respectively. This is equivalent to the emissions of 52 (MRI) and 25 (CT) cars driven annually. Energy consumption accounted for the largest portion of emissions (58% for MRI, 33% for CT), followed by disposable supplies (26% for MRI, 16% for CT), capital equipment production (7% for MRI, 13% for CT), and linens (4% for MRI, 11% for CT). Switching to solar photovoltaic electricity could reduce total MRI emissions by 70% and CT emissions by 40%, increasing the relative impacts of scanner production, disposable supplies, and linens. DISCUSSION/CONCLUSIONS:This study highlights the significant environmental impact of MRI and CT services, particularly energy consumption. Renewable energy sources, such as solar photovoltaics, offer the greatest potential for mitigating the environmental footprint. Additional strategies include optimizing scanner utilization, adopting reusable or reprocessable supplies, and embracing circular business practices such as circular manufacturing and extending the lifespan of capital equipment.

OBJECTIVE:To assess the environmental impact of radiography and fluoroscopy, using life cycle assessment (LCA), focusing on energy use and emissions. METHODS:This ISO 14040-guided LCA-based study focused on radiography and fluoroscopy services, including the production and use of two radiography and two fluoroscopy machines, at a quaternary care 800-bed academic medical center in the Southeastern United States over a 1-year period. Data were collected through direct observation, record review, staff interviews, and energy metering. Environmental impacts were assessed using SimaPro 9.3.0.2 and the Ecoinvent v3.8 database. RESULTS:e per scan). Medical linens or textiles accounted for 24% of total emissions. Other significant environmental impacts included ozone depletion, smog, acidification, and eutrophication. DISCUSSION/CONCLUSIONS:Reducing energy consumption by decarbonizing electricity sources and optimizing equipment use can significantly decrease greenhouse gas emissions. Implementing sustainable practices in linen use, procurement, and end-of-life management is also crucial. Reducing low-value imaging can further mitigate environmental impact.

BACKGROUND AND OBJECTIVE/OBJECTIVE:The health care sector is a significant contributor to greenhouse gas (GHG) emissions, and assessments of the environmental impacts of health services are essential. We aimed to evaluate the environmental impact of a highly common but controversial urology-specific blood test: the prostate-specific antigen (PSA) test. METHODS:e). The secondary outcome was the health impact attributed to the environmental harm of the test. KEY FINDINGS AND LIMITATIONS/UNASSIGNED:e, equivalent to driving 14.5 million miles, with a resulting human health impact of 6.6 disability-adjusted life years annually. This study focused on the PSA test itself, and not on emissions from staff, patient, or sample transportation; building infrastructure; or cleaning. CONCLUSIONS AND CLINICAL IMPLICATIONS/CONCLUSIONS:Although the carbon footprint of a single PSA test is small, the cumulative impact of the estimated total of 30 million PSA tests performed annually in the USA is substantial, especially when considering that a notable proportion of these tests may be performed on men who are unlikely to benefit.

INTRODUCTION/BACKGROUND:There is increasing prevalence of single-use flexible laryngoscopes in Otolaryngology. This study aims to quantify and compare the environmental outcomes of single-use disposable flexible laryngoscopes (SUD-Ls) and reusable flexible laryngoscope (R-Ls). METHODS:-eq) and analyzed using the US EPA's TRACI and SimaPro software. Monte Carlo sensitivity analyses were additionally performed. RESULTS:-eq). Notably 63% of the R-L total GHGs were due to personal protective equipment (PPE) production and disposal used in reprocessing, whereas 79% of SUD-L total GHGs were attributed to scope manufacturing and production. In a break-even analysis, a R-L produces fewer lifespan GHGs than SUD-Ls after 82 uses. CONCLUSION/CONCLUSIONS:Reusable flexible laryngoscopes pose an environmental benefit over SUD-Ls across several impact categories when used in high frequency. SUD-Ls have significant advantages in various situations: low utilization settings, in-patient/ED consults, and urgent need for sterile instrumentation. Providers should assess laryngoscope use frequency, site of use, and available resources to balance the environmental consequences. Further areas of sustainable optimization include reducing disposable PPE used in R-L reprocessing. LEVEL OF EVIDENCE/METHODS:N/A Laryngoscope, 2024.

BACKGROUND:Healthcare is a major contributor to global greenhouse gas emissions. Colorectal cancer (CRC) screening is one of the most widely used healthcare services in the US, indicated for approximately 134 million adults. Recommended screening options include fecal immunochemical tests (FITs) every year, CT colonographies (CTCs) every 5 years, or colonoscopies every 10 years. We compared the environmental impacts of these tests and identified opportunities for impact reduction. METHODS:We conducted a comparative life cycle assessment of three CRC screening strategies at the University of California, San Francisco. We performed on site audits to document the materials and energy used for each screening test. We used the ReCiPe 2016 method to estimate the environmental impacts of these procedures, measured by global warming potential (GWP) and damage to human health. We estimated the 10-year cumulative impacts of each screening strategy using a Markov reward model. We accounted for model uncertainty using hierarchical Monte Carlo simulations. FINDINGS/RESULTS:FIT-based screening had the lowest environmental impacts, with a roughly 20% margin of superiority over colonoscopies, and this finding was robust in sensitivity analyses. Across tests, the biggest cause of environmental harm was car-based transportation of patients and staff. Prioritizing FITs over screening colonoscopies in the US could enhance population health by roughly 5.2 million disability adjusted life years per decade. Transitioning to electric vehicles could reduce the GWP of all screening tests by 15-20%. INTERPRETATION/CONCLUSIONS:Given the similar efficacy and safety of these tests, payors should prioritize FITs for low-risk patients. Government initiatives to decarbonize transportation, incentivize telehealth, and mandate environmental product declarations will help reduce the environmental impacts of healthcare more generally. Our results call for a closer look at resource-intensive preventative health strategies, which could result in more harm than good if applied to a low-risk population. FUNDING/BACKGROUND:NIH, UCSF.

(1) Background: Healthcare is a major contributor to global greenhouse gas (GHG) emissions, especially within the surgical suite. Ophthalmologists play a role, since they frequently perform high-volume procedures, such as cataract surgery. This review aims to summarize the current literature on surgical waste and GHG emissions in ophthalmology and proposes a framework to standardize future studies. (2) Methods: Protocol and reporting methods were based on PRISMA guidelines for scoping reviews. Articles that reported any quantitative measurement of waste or GHGs produced from ophthalmic surgeries were eligible for inclusion. Commentaries, opinion papers, reviews and articles in a non-English language were excluded. (3) Results: A total of 713 articles were reviewed, with 10 articles found to meet inclusion criteria. Six studies produced level 3 evidence, two level 4 evidence, and one level 5 evidence. According to studies, most of the GHGs came from procurement of surgical materials, followed by travel emissions and building energy. (4) Conclusions: Research on waste and GHGs produced in ophthalmic surgery is limited, and existing studies utilize varied approaches to quantify this waste. We propose a standardized waste-lifecycle framework for researchers to organize future research. Such standardization will help in comparing studies and may uncover more opportunities to implement impactful waste reduction strategies in ophthalmology.