The Environmental Impact of Short-Stay Total Shoulder Arthroplasty

The healthcare sector significantly affects the environment, with hospitals consuming more energy and producing more waste than other nonresidential buildings. The shift toward outpatient total shoulder arthroplasty (TSA) is driven by increasing demand and cost reduction, yet the environmental implications of this remain poorly understood. We hypothesize that the inpatient stay accounts for 20% of TSA's environmental impact. This study aims to quantify the environmental impact of TSA using life cycle analysis (LCA) and waste audit, and to identify opportunities for sustainability.

Patients eligible for outpatient TSA between June 2023 and March 2024 were included. LCA evaluated 4 phases of care: preoperative (preop), operative (OR), postanesthesia care unit (PACU), and a 23-hour inpatient stay. Waste audits quantified surgical and inpatient waste. Patient demographics were collected through chart review.

Twenty-one patients (average age 62 years) were included. Average surgical and inpatient waste was 19.6 kg (12.3 kgCO₂e) and 4 kg (2.73 kgCO₂e), respectively. Average total TSA emissions were 148.2 kgCO₂e, equivalent to driving 379 miles in a gasoline-powered vehicle. Emissions by phase: OR (61%), anesthesia (27%), inpatient (9%), preop (2%), and PACU (1%). Major contributors included anesthetic supplies, surgical packs, and anesthetic medications.

TSA's environmental impact may be mitigated by performing outpatient procedures, minimizing inhaled anesthetics, adopting reusable devices, and customizing surgical packs. Recognizing the environmental implications of surgical practices is essential to balancing patient care, public health, and environmental sustainability.

Level IV. See Instructions for Authors for a complete description of levels of evidence.