Operating rooms have big carbon footprints too!
(Originally published in The Sudbury Star on Mar. 20, 2021)
When you think about our health care system, what comes to mind? Bed shortages and wait times? As a physician, I hope you also think of help. Help with maintaining your health and finding healing when sickness or injury come your way.
Help. Health. Healing. That’s what health care systems are supposed to be about. So it’s something of an oxymoron that a system intended for health is harming the health of the planet. And it’s time we face reality: people cannot stay healthy on a sick planet.
We all know that hospitals generate tonnes of garbage. But the harm I’m focusing on today is greenhouse gas (GHG) emissions. Canada’s health care system coughs out 5 percent of Canada’s total emissions, which are among the worst in the world. The American health industry is even worse: it hacks out 8-10 percent of US emissions. Health care emissions arise from many sources, like heating, cooling, and powering hospitals; doctors, nurses, and administrators driving their gas guzzlers to work; and the manufacture and transport of medical equipment, drugs, and supplies (like PPE) from as far away as China. Like everything these days, it’s complicated.
However, a few things are crystal clear. Within our health care system, hospitals are the biggest problem, and our operating rooms (ORs) are the worst offenders. Operating rooms are extravagant consumers, and they produce copious quantities of greenhouse gases and garbage. You might think that garbage and gases are an unavoidable consequence of modern health care, but some ORs manage to do the job with significantly lower emissions than others.
In 2017, Vancouver surgeon Andrea MacNeill and colleagues analysed the carbon footprints of ORs at three large hospitals, located in Vancouver, Minneapolis, and Oxford, UK. There were both similarities and some astounding differences. All three ORs had high emissions, but not necessarily for the same reasons. The biggest differences were the result of two main factors:
1) Energy: For heating, cooling, ventilation, and equipment;
2) Anesthetic gases: They help make surgery painless but they’re also nasty greenhouse gases. And among the available options, one stands out as positively nefarious. Desflurane heats up the planet some 26 times more than its first-cousin Isoflurane.
In coal-burning Oxford, 84 percent of the OR’s emissions came from energy consumption. In Vancouver, where energy comes mostly from natural gas and clean sources like hydropower, that number was only 17 percent. That’s a striking difference.
On the other hand, in the Minneapolis and Vancouver hospitals, anesthetic gases accounted for over half of OR emissions, compared with only 4 percent in Oxford. Why? The answer is simple: Oxford doesn’t use Desflurane!
Now imagine if the Oxford hospital could get rid of coal, or if Vancouver decided to banish the use of Desflurane! Either way, the result would be operating rooms with dramatically lower emissions.
Individual hospitals can try to be more energy-efficient, but they don’t have much control over where their electricity comes from. Desflurane is a different issue altogether. It’s low-hanging fruit. Easy to pluck off the tree and get rid of. Or at least it should be. Desflurane has minimal if any advantages over Isoflurane. It’s also more expensive! So why is it still in frequent use in Ontario’s operating rooms in 2021?
Here’s the main reason: It’s because physicians, administrators, governments, and patients aren’t in the habit of asking 21st century health questions, like what is the environmental impact of the equipment we’re using, the tests or treatments we’re recommending, the drugs or gases we’re prescribing??
Changing habits is a slow process. But if a carbon tax were applied to anesthetic gases, Desflurane would disappear from hospitals almost immediately. It would be unaffordable.
But I’ll finish with some good news. At least one hospital has already gotten rid of Desflurane, and it’s right here in Northern Ontario. Find out which one in my next column!
Elaine Blacklock M.D. F.R.C.P.(C)
Sources:
MacNeill, A et al. “The impact of surgery on global climate.” Lancet Planetary Health 2017; 1:e381. https://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(20)30121-2/fulltext
Lenzen, M et al. “The environmental footprint of healthcare: a global assessment.” The Lancet Planetary Health. July, 2020. https://www.sciencedirect.com/science/article/pii/S2542519620301212?via%3Dihub