Abstract
Purpose :
Research regarding the environmental impact of ophthalmic surgery is sparse, particularly pertaining to retinal surgery. The United States has been shown to produce higher carbon emissions for cataract surgery when compared to a developing country. This observational comparative study was performed to determine the amount of waste being produced from retinal surgeries in a tertiary care non-profit hospital in the United States and a tertiary care governmental hospital in Pakistan.
Methods :
Retinal surgeries were observed over a six week period (June-July 2022) at Montefiore Medical Center (MMC), (Bronx, NY, USA) and Lahore General Hospital (LGH) (Lahore, Pakistan) with IRB approval from both sites. Solid waste (excluding sharps) was weighed at the end of each individual procedure using matching calibrated digital scales and recorded. Total quantities of waste and then subsets of procedure length, procedure type, and complexity of patient diagnosis were compared. For further analyses, select cases were matched by procedure length, procedure category, and complexity of patient diagnosis.
Results :
A total of 67 retinal surgeries were observed (27 MMC and 40 LGH). Analysis of overall data shows that MMC produced 13.7 times more waste than LGH (MMC Mean 7.13kg, SD 1.80kg; LGH Mean 0.52kg, SD 0.18kg). Figure 1 shows that MMC waste production increased as a function of case time (R2=0.302), while LGH waste production remained relatively consistent despite increasing procedure length (R2=0.003). When stratified by patient diagnosis (Fig. 2a) and procedure type (Fig. 2b), MMC consistently produced more waste within each category. As shown in Figure 3, when six matched cases (three pairs) were compared, MMC still produced an average of 14.8 times more solid waste.
Conclusions :
As shown in similar studies evaluating cataract surgery, our study shows that a tertiary care facility in the United States produces significantly more solid waste per surgical procedure when compared to a facility in Pakistan. MMC utilizes more disposable instruments and materials, while LGH used reusable and re-sterilized items, which could explain the difference. Future studies should focus on understanding models like the one at LGH in order to identify opportunities for waste and carbon footprint reduction at facilities like MMC, while still prioritizing patient outcomes.
This abstract was presented at the 2023 ARVO Annual Meeting, held in New Orleans, LA, April 23-27, 2023.