The healthcare sector is responsible for approximately 4.6% of global greenhouse gas emissions. If healthcare were a country, it would be the fifth-largest emitter in the world. Within this sector, operating rooms (ORs) are a high-impact area: they generate 20–33% of all hospital waste, while their energy consumption is three to six times higher than that of other hospital departments. According to a report by CMAJ, the ecological footprint of ORs can be drastically reduced through the replacement of anesthetic gases, improved energy efficiency, and circular waste management.
The study emphasizes that the environmental impact of surgical care is cumulative. Direct emissions (Scope 1), such as anesthetic gases; purchased energy (Scope 2); and indirect impacts from the supply chain (Scope 3) together form the footprint that modern medicine must reduce.
Anesthetic Gases: The Invisible 2,500-Fold Multiplier
One of the most startling findings of the study concerns the Global Warming Potential (GWP) of inhaled anesthetics. Most gases used for anesthesia are potent greenhouse gases that are vented from the OR directly into the atmosphere.
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Desflurane: According to the study, this gas is the “black sheep.” Its GWP value is 2,540, meaning it warms the atmosphere 2,540 times more powerfully than carbon dioxide. Using just one bottle of desflurane results in emissions equivalent to 800 kilograms of $CO_2$.
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Sevoflurane: In contrast, sevoflurane has a GWP of only 130. The research highlights that abandoning desflurane in favor of sevoflurane or intravenous anesthesia can alone reduce the carbon footprint of anesthesia by 90%.
Energy Demand and “Idle” Operating Rooms
Operating rooms have extremely high energy requirements, primarily due to specialized heating, ventilation, and air conditioning (HVAC) systems. These systems must completely replace the air 15–20 times per hour to maintain sterility and reduce infection risks.
The CMAJ study notes that energy demand often remains high even when the OR is not in use. Researchers recommend:
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Night Mode: Reducing air exchange rates during non-operational periods results in significant savings.
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LED Technology: Replacing traditional surgical lights with LEDs not only cuts electricity consumption but also generates less heat, thereby lowering cooling requirements.
The Waste Hierarchy and the “Five Rs”
In managing OR waste, the study proposes the principles of Reduce, Reuse, Recycle, Rethink, and Research. Currently, the majority of surgical waste consists of single-use items, the production and disposal of which are extremely energy-intensive.
“The supply chain (Scope 3) is responsible for 71% of total healthcare carbon emissions. Therefore, changing procurement strategies is the most important step.”
The study provides specific examples for replacing single-use items:
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Textile vs. Paper: Utilizing reusable, sterilizable surgical gowns and drapes significantly reduces waste volume.
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Device Reprocessing: Many devices labeled as “single-use” (such as certain electrocautery tools) could be safely reprocessed through specialized protocols, reducing both procurement costs and environmental impact.
The Need for Systemic Change
The CMAJ article concludes that a sustainable operating room is not merely a series of individual choices. It requires cooperation between administration, the pharmaceutical industry, and engineers. “Green surgery” cannot mean a compromise at the expense of patient safety, but research proves that using sevoflurane or sterilizing textiles has no negative impact on clinical outcomes.
The path forward lies in medical devices equipped with digital passports and integrating sustainability metrics (such as carbon footprints) into hospital performance evaluations.
Official Sources and References:
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Original Study: CMAJ – Sustainability in the operating room (2026)
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Related Source: Canadian Medical Association – Climate Change and Health
Image by Franklin Alvear from Pixabay
