Theatre-Based Carbon Footprint of Five Common Orthopaedic Trauma Procedures: A Single-Centre Comparative Analysis

Introduction  Operating theatres are resource-intensive environments and contribute disproportionately to healthcare-related carbon emissions. While the environmental impact of elective orthopaedic surgery has been described, there are limited procedure-level data for orthopaedic trauma surgery. Methods  A single-centre, retrospective, theatre-based carbon footprint analysis was undertaken for five common orthopaedic trauma procedures performed in 2023: hip hemiarthroplasty, sliding hip screw fixation, femoral intramedullary nailing, ankle fracture fixation, and minor trauma procedures. Consumables and selected instrument-related items were weighed and assigned material-specific emission factors. Theatre energy and water use were estimated using assumed theatre-level averages and allocated by operative duration. Emissions were expressed as kilograms of carbon dioxide equivalent (kgCO₂e) per procedure. Results  Theatre-based emissions ranged from 33.3 to 49.8 kgCO₂e per procedure. Hip hemiarthroplasty had the highest emissions, while minor procedures had the lowest. Consumables accounted for 34% of total emissions, with single-use gowns and drapes contributing 37% of consumable-related emissions. Allocated theatre energy and water use accounted for 55.8% of emissions and were similar across procedures. Conclusion  Common orthopaedic trauma procedures have similar theatre-based carbon footprints, with variation driven primarily by consumable use. Although absolute emissions are underestimated owing to exclusion of supply-chain sources, this analysis identifies intra-operative emission hotspots that may inform local quality improvement initiatives.