Instrument Tray Standardization for Pediatric Laparoscopic Appendectomy: A Sustainability Initiative

Healthcare-related carbon dioxide emissions (CO₂e) account for 8.5% of national greenhouse gas emissions, with high-volume disposable instrument use and high-energy sterilization of reusable instruments as large contributors. Instrument standardization for common surgical procedures has been shown to reduce cost, but few studies have evaluated the environmental impact of this practice. We sought to evaluate the association between instrument-based carbon emissions and instrument tray standardization for pediatric laparoscopic appendectomy.

A collaborative multidepartmental needs assessment was performed at a tertiary academic medical center to create a standardized instrument tray for laparoscopic appendectomy cases. Following tray implementation, a retrospective cohort study of children (≤ 18 y) who underwent laparoscopic appendectomy between January 8, 2022 and January 4, 2024, was conducted. Outcomes included instrument-based carbon footprint per case (kilograms of CO₂e), number of instruments used per case (disposable, reusable), instrument-based cost per case, and procedure time. Outcomes were compared before and after standardized tray implementation using Mann-Whitney U and chi-square tests.

Fifty-three patients underwent laparoscopic appendectomy with no difference in demographic/clinical characteristics or 30-d clinical outcomes before versus after standardized tray implementation. Postimplementation, the median carbon footprint per case decreased from 113.2 kg CO₂e to 75.5 kg CO₂e (P = 0.04). The median number of disposable instruments (P < 0.001), reusable instruments (P = 0.02), and instrument trays (P < 0.001) used per case also decreased after implementation. However, total procedure time (P = 0.695) and instrument-based cost per case (P = 0.087) did not decrease significantly.

Instrument tray standardization for pediatric laparoscopic appendectomy may reduce our carbon footprint by decreasing the volume of instruments used per case. These findings highlight the environmental benefits of optimizing instrument variability in pediatric surgery.