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Pediatric Supracondylar Humerus Fracture Pinning: Are We Leaving Unnecessary Waste and Cost on the Table?
Olivia Brauer1, Samuel Noonan2, Brittany N Garcia1,3
1University of Utah Department of Orthopaedic Surgery, Salt Lake City, UT, USA.
Insights
Pediatric elbow fracture surgery generates significant waste. A semi-sterile approach dramatically cuts emissions and waste, particularly from surgical drapes and packaging, improving environmental stewardship and care value.
Area of Science:
- Orthopedic Surgery
- Environmental Science
- Health Economics
Background:
- Supracondylar humerus (SCH) fractures are the most common pediatric elbow injury requiring surgical intervention.
- Current closed-reduction and percutaneous pinning (CRPP) procedures for SCH fractures generate substantial waste and associated costs.
- Semisterile techniques offer a potential avenue for waste reduction and improved patient outcomes in pediatric orthopedic surgery.
Purpose of the Study:
- To quantify the environmental impact of CRPP for SCH fractures using life cycle assessment (LCA).
- To identify specific areas of waste generation and environmental harm in the procedure.
- To evaluate the potential of semisterile setups to reduce resource consumption and environmental harm.
Main Methods:
- A waste audit was performed on a single SCH CRPP operation.
- A semisterile setup was modeled based on existing techniques.
- Waste was calculated based on surgeon preference cards, intraoperative requests, and anesthesia supplies, with material specifications analyzed using LCA software (SimaPro) and the TRACI 2.1 impact assessment tool.
Main Results:
- A standard SCH CRPP procedure generated 6.85 kg of landfill waste and 28.4 kg CO2 equivalent emissions.
- Disposable items like drapes and packaging were major contributors to emissions (18.2 kg CO2 eq).
- A semisterile setup resulted in a 67% reduction in procedural emissions.
Conclusions:
- CRPP surgery for pediatric SCH fractures has a significant environmental footprint due to waste and emissions.
- Semisterile setups substantially reduce waste and emissions, particularly from disposable supplies like drapes and gowns.
- Adopting waste-reducing strategies aligns with environmental stewardship, enhances patient care value, and lowers supply/disposal costs.
Background:
Supracondylar humerus (SCH) fractures are both the most common elbow injury and surgically treated fracture in children. Closed-reduction and percutaneous pinning (CRPP) of SCH fractures generates significant financial costs and waste. Recent studies have highlighted semisterile techniques as an opportunity to reduce unnecessary waste, with benefits to patient safety and outcomes. This study aims to quantify the environmental impact of this procedure using life cycle assessment (LCA) to identify opportunities for resource stewardship, reduction of environmental harm, and promotion of high-value care.
Methods:
A waste audit was conducted for a single SCH CRPP operation and a semi-sterile setup was modeled based on previously reported techniques. Waste attributable to items from the surgeon's preference card was calculated. Additional waste attributable to intraoperative requests and anesthesia supplies was evaluated separately. Each item and its component materials were weighed individually. Material specifications were extracted from manufacturer technical data sheets. The waste contributions of each material were calculated and analyzed using the Ecoinvent 3 database in SimaPro 9.6.01 software. The TRACI 2.1 V1.09 impact assessment tool was used to describe environmental impacts.
Results:
A total of 6.85 kg of landfill waste and 28.4 kg CO2 equivalent emissions were generated per case. Disposable medical products, packaging and personal protective equipment (PPE) amounted to 18.2 kg CO2 eq. Reusable equipment required 8.0 kWh of energy (3.1 kg CO2 eq) to be sterilized. The preference card items with the greatest environmental harm were drapes and blue towels across 9 out of 10 impact categories. The semi-sterile setup yielded a 67% reduction in procedural emissions overall.
Conclusions:
CRPP surgery for SCH fractures generates substantial waste and emissions. This LCA demonstrates that a semi-sterile setup substantially reduces waste and emissions, particularly as it relates to disposable drapes, gowns and packaging. Minimizing waste reflects thoughtful resource and environmental stewardship, with meaningful benefits to the health of children now and in the future. Such efforts also reduce supply and disposal costs, with ramifications for improving the value of care for this common injury.
Key Concepts:
(1)Pinning of supracondylar humerus fractures creates significant climate change impacts through unnecessary disposable waste, contributing to detrimental population health.(2)Surgical drapes and blue towels are the most environmentally costly items utilized in a typical sterile pediatric supracondylar fracture pinning.(3)Semi-sterile or reduced preference card setups for pinning supracondylar fractures demonstrate great potential for reducing waste and carbon footprint.
Level Of Evidence:
II.
