Quantifying Solid Waste Production and Sustainability Barriers in Pediatric Orthopaedic Surgery: A Mixed-methods Study.

BACKGROUND

Climate change presents a critical public health challenge, and the health care sector is a substantial contributor to greenhouse gas emissions. Operating rooms generate a disproportionate share of hospital waste, with orthopaedic surgery producing more waste than any other specialty. However, waste production in pediatric orthopaedic surgery remains poorly studied. This study aimed to quantify solid waste generated during common pediatric orthopaedic procedures and assess the perspectives of operating room staff regarding sustainability practices and barriers to waste reduction.

METHODS

A mixed-methods study was conducted at 2 affiliated pediatric hospitals. Solid waste audits were performed on 20 pediatric orthopaedic surgeries, including anterior cruciate ligament reconstruction, pelvic osteotomy, elbow fracture fixation, and posterior spinal fusion. Waste was collected and weighed separately during the preoperative and intraoperative periods, categorized as recyclable or nonrecyclable. Descriptive statistics and t tests were used to compare waste production across procedures and time periods. In addition, a survey assessing attitudes toward sustainability and perceived barriers to waste reduction was distributed to surgeons, residents, circulators, and scrub technicians. Qualitative responses were analyzed using inductive content analysis.

RESULTS

The average solid waste generated per procedure was 15.02 kg (SD: 9.26). Posterior spinal fusion produced the highest waste (29.49 kg), followed by pelvic osteotomy (13.40 kg), anterior cruciate ligament reconstruction (9.96 kg), and elbow fixation (7.24 kg). None of this waste was recycled at the primary study sites. Extrapolated to institutional surgical volumes, these 4 procedures contributed an estimated 5.03 metric tons of solid waste in 2024. Survey responses (n = 13; 39% response rate) identified unnecessary opening of supplies and lack of recycling infrastructure as key contributors to waste. Participants reported minimal sustainability education but expressed interest in institutional support to improve practices.

CONCLUSIONS

Pediatric orthopaedic surgery generates substantial solid waste. Despite staff awareness of the environmental impact, systemic barriers limit sustainable practices. Targeted strategies, including recycling infrastructure, preference card optimization, and staff education, are needed to reduce waste in the pediatric orthopaedic operating room.

LEVEL OF EVIDENCE

Level III-cross-sectional study.