Carbon Footprint in Orthopedic Surgery: Assessment of Single use Material versus Reusable Sets for Treatment of Distal Radius Fracture

Background:
Climate change is a growing threat to public health. As a paradox, healthcare produces greenhouse gases (GHG) responsible for this. Carbon footprint (CF) estimates GHG emissions but is underdeveloped in healthcare. To date, there is a lack of assessment in orthopedic surgery.

Distal radius fractures are part of the most common surgical fractures. When surgery is needed, volar plate fixation is often chosen. With the development of single-use set, cost-saving and time-saving have been studied. Its ecological impact remains unknown.

Our purpose is to assess the CF of single-use and reusable sets for distal radius fixation, from their production to their use.

Methods:
Life cycle assessment of those 2 sets, produced by the same French society, was performed. CF was measured for each set in a teaching and a private hospital in Paris. GHG emissions of production, distribution, and use have been calculated and converted into carbone dioxide equivalent (kgCO2).

Findings:
Production of a reusable set is 28 times more emissive than a single-use set (725 kg CO2 Vs 26 kgCO2). For one case, use of a reusable set is 8 times more emissive than a single-use set (10,2 Vs 1,3 kgCO2) & it doubles in a private hospital. The gap is reduced with repetitive use but remains in favor of single-use set, even for 200 cases/year (26 Vs 41 kgCO2). At the hospital, sterilization and cleaning account for the majority of GHG emissions (6,4 kgCO2).

Scenarios of use in Germany & Australia show that the gap is raised up to 65 kgCO2 and 117 kgCO2 respectively, due to GHG emissions in distribution and energy-use during consumption.

Interpretation:
CF of single-use set is less important than reusable set. Orthopedic surgeons should be aware of those results. Additional research is needed to estimate the resulting pollution of waste treatment.