Presented by Royce Lee
Characterizing the Burden of Intraoperative Urological Surgical Waste: Opportunities for Reduction and Mitigation
R. Lee, A. Griggs-Demmin, A. Cohen
Johns Hopkins University School of Medicine, Baltimore, MD, USA
Introduction and Objective: In the US, each hospital patient produces about 15.33kg of waste daily, resulting in 5.5 million metric tons of waste every year. The burden of urologic surgical waste has not yet been fully examined. This study aimed to establish baseline estimates of the various types and amounts of intraoperative urological surgical waste, to understand the scope of the problem.
Methods: Data from 31 cases among four surgeons at an urban academic center between July and September of 2021 were analyzed. Three waste streams were measured: regulated medical waste (RMW), normal solid waste (NSW), and laundered linens (LL). Data collection began when the OR team started preparing the room and ended when the team disposed of personal protective equipment. A waste catalog was recorded for each case.
Results: The average 11.11kg and 0.97m^3?generated per case translated to 344.41kg and 30.05m^3?of total waste. Mass and volume of RMW, NSW, and LL were significantly different between case types, with robotic generating the most and endoscopic generating the least (Figure 1). One-way ANOVA was used to compare mean mass and volume of waste streams between case types. In all cases, there was improper disposal of non-RMW items as RMW. The average length of case, in minutes, was 98 for open, 201 for robot-assisted, and 55 for endoscopic. NSW accounted for 52.7% of total waste weight, RMW for 31.3%, and LL for 16.0%.
Conclusions: The results demonstrate the excessive environmental and economic burden of urologic surgical waste, but also highlight opportunities for mitigation and reduction. These include proper waste segregation, better packaging of surgical equipment, and OR-based educational initiatives. Yeah. So the project that we were uh we're going to be presenting at the um ma A U A is going to be actually talking about um the waste that we produce in operative urological like surgeries essentially. Um And we just wanted to get a clear idea of what exactly um are um ours are like operative waste is just because we currently have no uh metric, no standard for just knowing how much is being produced in these situations. Um We have rough estimates of like what hospitals are producing, but this is like including all of like the um the medical side of care. But we are, we just want to essentially just characterize what the burden is for these operative waste. Um And just a little background on what exactly uh um why this is important is because uh the health care sector, I'm I'm sure most people know is a really big uh contributor to greenhouse gas emissions. Um not only in the US but also just worldwide. Um I think us hospitals, um I I think it's been estimated that they produce like about like £4 billion of waste every year. And it was just like um, Doctor Cohen uh was just like, it's, it's kind of crazy how like we produce so much waste and like all these like surgical equipments and all these like linens and like everything that we use in the operating room when caring for our patients that there is like no measure of this. Like it's just all going into like the landfills and um and he just wanted to be uh he wanted to create like a little more clarity on what exactly we're producing and like how we can mitigate this as much as possible to like address the climate crisis. Um Just because it is such a big burden. Also, it cost a lot of money for, um, for everyone just to clean up all this uh waste and like properly dispose of it. So, uh that's exactly what we did. Um We, we measured uh urological waste, um because uh Doctor Cohen is a urologist and uh we observed 31 cases um in a certain time period and we pretty much just measured everything from the beginning of the surgery to the end of surgery. And we just want to see like, all right, how much waste reproducing, how much does it weigh? How much volume does it take up? And what exactly are we throwing away? So we categorize um the, the waste into like three different categories. And these were laundered, linens, normal solid waste, which is gonna be like their plastics produced from uh like opening up all like the new surgical equipment or whatever um and also regulating medical waste. So this is gonna be like your biohazardous materials. And what we were able to see is actually on average, we were producing about 11 kg of waste per case. And this amounted to about like 1 m cubed of volume generate per case. And when you actually look at the breakdown of what exactly is going on in those three categories, the normal solid waste. So like again, like the plastics, um the screws, et cetera, um take up the majority of them. So it's like about 50% in this uh in our study that we found. So there's a lot of waste being produced and a lot of it is from just like packaging. Um just generally things that we just throw out. And it was also important to note that there are protocols placed in ors to try to help like organize the waste. So just so disposal pro the disposal process is as efficient and um waste uh cost effective as possible. But all 31 cases that we looked at actually deviated from the normal uh recommended disposal practices. Um And there's not like a fall on any of like the or teams, it's just, it's just not um super standardized, it, these are just recommended. Um And also it was interesting to note that there was no recycling put on the or so, everything that was being um like essentially thrown away is going to like the trash, the landfills. So um this was also um a place of uh importance to like, maybe we can do, do something about this to mitigate it. So I I think just overall, we were just able to see that there are further steps that we need to take in order to manage surgical waste. And this is not just a neurological um waste. It's also in any type of like um uh a medical specialty that involves an operating room just because operating rooms do produce a lot of waste. So this could be like different um specialties like ent plastics. Um and just having this idea that OK, we should be cognizant of the waste that we're producing. Um Although we are trying to maximize the, the care for the patient, we, we should also be taking steps so that we can like have like a healthier planet. Um And yeah, so that like um the next steps that we, that we were like thinking about were like just like proper segregation of the bent waste. Um the role of recycling and reusing better packaging for surgical equipment, which is something that Doctor Cohen is like a big proponent of just because um he sees all the waste and every time he opens a new, a new tool, a new, a new piece of equipment, it is just, it's just like a lot and just like just general um research expansion across other ors. So it's like a quick uh summary of what we were, what we will, we will be talking about the M MA A U A. Um Let me and you could be in whatever. OK, cool. Um So at the um ma A U A, um I'm going to be talking about um how we characterize the burden of inter intraoperative neurological surgical waste. Um And we just want to highlight some opportunities for reduction and mitigation. So what exactly we did was we observed 31 total cases um during a certain time period. Um and we measured what exactly um was being thrown away. And this started from the um from the beginning of the Oper operating room prep to the disposal of P pe um personal protective equipment. And we assessed um what exactly was being thrown away in three different streams. So we looked at launder linens, um normal solid waste, which is gonna be like your plastics and your like screws and like your equipment um equipment that you're being thrown away. And we have the regulated medical waste as the third one, which is like your bio hazardous materials that cannot be normally properly disposed of. And what we were able to see from this was actually that there is about 11 kg of waste being produced per case and about 1 m cubed of volume of waste generated per case. And when you actually look at the breakdown of this, um we were able to see that normal solid waste actually accounted for more than half of the total solid waste. So this is like all the plastics and like materials um that were being generated that took up a a lot of the of the volume and also the weight of what we were producing. It was also important to note that about 31 of all 31 of the cases deviated from normal recommended disposal practices and there's also no recycling protocol on the or so, the next steps for um that we would like to be uh uh shown to other urologists or just people in general. Uh is that surgical waste is a, is a big uh is a big factor that contributes to the overall health care waste. And we want to ensure that there's proper segregation um of normal solid waste and regulate medical waste just because it does um it does place a burden on the disposal process um by having um improper segregation. We also want to highlight a role, a potential role of recycling and reusing um of all the materials and um plastics are thrown away and just overall just, just having generally better packaging of surgical equipment. Um Doctor Ken is a big proponent of this just because he sees it day to day during his um uh neurological surgical cases, how much plastic waste is actually being produced from all the packaging. And it is like a, a big thing for him where he's just not very happy about it. And also um we just want to just expand research um of this very important cause to other ors not only in your urological cases, but other medical specialties just to highlight the um the burden of waste.