Environmental Impact of Adult Tonsillectomy: Life Cycle Assessment and Cost Comparison of Techniques
Corresponding Author
Duncan A. Meiklejohn MD
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico Hospital, Albuquerque, New Mexico, U.S.A.
Send correspondence to Duncan A. Meiklejohn, MD, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, MSC10 5610, University of New Mexico, Albuquerque, NM 87131.
Email: [email protected]
Search for more papers by this authorZafrul H. Khan
Department of Civil Engineering, University of New Mexico, Albuquerque, New Mexico, U.S.A.
Search for more papers by this authorKaryn M. Nuñez MD
Alaska Native Tribal Health Consortium, Providence Anchorage Anesthesia Medical Group, Anchorage, Alaska, U.S.A.
Search for more papers by this authorLee Imhof PE
Department of Planning and Construction, University of New Mexico Hospital, Albuquerque, New Mexico, U.S.A.
Search for more papers by this authorSabah Osmani MD
University of New Mexico School of Medicine, Albuquerque, New Mexico, U.S.A.
Search for more papers by this authorAmaris C. Benavidez
University of New Mexico School of Medicine, Albuquerque, New Mexico, U.S.A.
Search for more papers by this authorRafiqul Tarefder PhD, PE
Department of Civil Engineering, University of New Mexico, Albuquerque, New Mexico, U.S.A.
Search for more papers by this authorCorresponding Author
Duncan A. Meiklejohn MD
Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico Hospital, Albuquerque, New Mexico, U.S.A.
Send correspondence to Duncan A. Meiklejohn, MD, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, MSC10 5610, University of New Mexico, Albuquerque, NM 87131.
Email: [email protected]
Search for more papers by this authorZafrul H. Khan
Department of Civil Engineering, University of New Mexico, Albuquerque, New Mexico, U.S.A.
Search for more papers by this authorKaryn M. Nuñez MD
Alaska Native Tribal Health Consortium, Providence Anchorage Anesthesia Medical Group, Anchorage, Alaska, U.S.A.
Search for more papers by this authorLee Imhof PE
Department of Planning and Construction, University of New Mexico Hospital, Albuquerque, New Mexico, U.S.A.
Search for more papers by this authorSabah Osmani MD
University of New Mexico School of Medicine, Albuquerque, New Mexico, U.S.A.
Search for more papers by this authorAmaris C. Benavidez
University of New Mexico School of Medicine, Albuquerque, New Mexico, U.S.A.
Search for more papers by this authorRafiqul Tarefder PhD, PE
Department of Civil Engineering, University of New Mexico, Albuquerque, New Mexico, U.S.A.
Search for more papers by this authorAbstract
Objectives
To quantify and compare the cost and environmental impact of different techniques for adult tonsillectomy surgery, and to identify target areas for impact reduction.
Methods
Fifteen consecutive adult tonsillectomy surgeries were prospectively randomized to one of three tonsillectomy techniques: cold, monopolar electrocautery, or low-temperature radiofrequency ablation (Coblation). Life cycle assessment was used to comprehensively evaluate the environmental impact of study surgeries. Outcomes assessed included multiple measures of environmental impact, including greenhouse gas (GHG) emissions, and cost. Environmental impact measures were analyzed to identify highest-yield areas for improvement, and outcomes were compared between surgical techniques using statistical analysis.
Results
GHG emissions for cold, monopolar electrocautery, and Coblation techniques were 157.6, 184.5, and 204.7 kilograms of carbon dioxide equivalents (kgCO2-eq) per surgery, respectively, with costs totaling $472.51, $619.10, and $715.53 per surgery, respectively. Regardless of surgery technique, anesthesia medications and disposable equipment contributed most to environmental harm. Cold technique demonstrated reduced environmental impact related to disposable surgical equipment in the categories of greenhouse gas emissions, acidification of soil and water, eutrophication of air, ozone depletion, release of carcinogenic, and non-carcinogenic toxic substances, and respiratory pollutant production (p < 0.05 for all comparisons with other techniques).
Conclusion
Within the boundaries of operating room processes, cold technique minimizes cost and environmental impact of adult tonsillectomy surgery, with statistical significance noted in the impact of disposable surgical equipment. Areas of highest potential for improvement identified include reducing use of disposable equipment and collaboration with the Anesthesiology care team to streamline medication use.
Level of Evidence
2, randomized trial Laryngoscope, 134:622–628, 2024
Supporting Information
| Filename | Description |
|---|---|
| lary30866-sup-0001-Supinfo.docxWord 2007 document , 20.9 KB | Data S1. Supplement Methods. Methods described in the supplement include definition of study goals and scope, methods used to quantify the environmental impact of anesthetic gases, and statistics and uncertainty analysis used. |
| lary30866-sup-0002-FigureS1.pdfPDF document, 5.2 MB | Supplementary Figure 1. Environmental impacts for each technique by source. See Table I for full description of impact categories. Facilities = electricity and natural gas consumed in the OR by HVAC, lighting, and durable equipment, Laundry = manufacture, laundering and disposal of reusable surgical linens, Anesthesia Pharmaceutical = pharmaceuticals used by the Anesthesia care team, Anesthesia Disposable = disposable equipment used by the Anesthesia care team including manufacture and disposal, Surgical Reusable = reusable surgical equipment including manufacture, sterilization and instrument reprocessing, and disposal, Surgical Disposable = disposable surgical equipment including manufacture and disposal, ME = monopolar electrocautery, GHG = greenhouse gas emissions, kg = kilogram, CO2-Eq = carbon dioxide equivalents, H + -Eq = hydrogen ion equivalents, 2,4-D-Eq = 2,4-Dichlorophenoxyacetic acid equivalents, N = nitrogen, CFC-11-Eq = trichlorofluoromethane equivalents, PM2.5-Eq = pollution equivalent to particulate matter of 2.5 microns or less. |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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