Sustainability in surgery: comparison of waste management optimization between two European centers

Abstract Introduction Since healthcare contributes with 4–10% to global greenhouse gas emissions, sustainable surgical practices are essential. The study compares the implementation of a waste recycling protocol (WRP) in the operating rooms of two hospitals: Cattinara University Hospital (CU) and Sahlgrenska University Hospital (SU). The aim was to quantify biocontaminated waste management before and after WRP. Method At CU, after waste monitoring (November 2023-March 2024), a structured WRP was introduced, including containers for plastic, glass, paper, metal, general and biocontaminated waste, staff training, and informative posters, and the results were recorded (June 2023-April 2024). At SU, waste was monitored from February to April 2024, along with number/type of surgical procedures. CO₂-equivalent (CO₂e) emissions were calculated using standardized emission factors for each waste category. Result Before WRP at CU, 2,203 kg waste were produced (all “biocontaminated”), resulting in 8,371kg CO₂e and €3,082 costs. After WRP, 11,689kg of waste were generated, of which 2,549kg (21.8%) was recycled. CO₂e was reduced by 5,133kg (11.6%) with cost savings of €2,203 (13.5%). At SU (26 surgical procedures: 46 % open, 54% laparoscopic), 376kg waste was produced: 2.5% cardboard, 3.9% plastic, 53.7% general, and 36.7% biocontaminated waste. CO₂e was 1,597kg: 63.2% from general and 32.8% from biocontaminated waste. WRP implementation started in January 2025. Discussion Recycling in operating rooms is feasible and effective when paired with staff training and targeted infrastructure changes. The results highlight the potential for waste reduction and carbon savings through systematic waste segregation and support broader adoption of sustainability strategies for environmentally responsible and resource-efficient surgery.