S1294 Assessing the Environmental Benefit of Performing Gastrointestinal Endoscopies in Ambulatory Surgery Centers

Introduction: Ambulatory Surgery Centers (ASCs) are increasingly used for gastrointestinal endoscopies (GIEs), offering advantages like lower cost, greater efficiency, and improved patient experience - alongside the potential for a smaller environmental footprint. GIEs contribute significantly to healthcare waste, generating an estimated 40,000 to 60,000 metric tons annually in the United States. However, most available data come from hospitals and academic centers, with limited reporting from ASCs. This study aims to compare medical waste produced during GIEs at 2 ASCs and evaluate its environmental impact against other sites of care. Methods: A prospective audit of medical waste was conducted for GIEs performed by 1 gastroenterologist at 2 ASCs in the United States. ASC1 is a multi-specialty center with 8 operating rooms; waste was measured over 12 months (7/2023–7/2024). ASC2 is a GI-only center with a single OR; waste was measured over 5 months (8/2023-12/2023). Waste was categorized (landfill vs biohazard), weighed, and analyzed. Recyclable materials were processed separately and excluded from calculations. Results: In ASC1, 549 endoscopies generated 306.68 kg of waste from the exam room, averaging 0.547 kg per case (72.9% landfill, 27.1% biohazard). In ASC2, 277 endoscopies produced 284.22 kg of procedural waste (1.026 kg per case; 62.2% landfill, 37.8% biohazard), with an additional 212.51 kg from perioperative areas (0.764 kg per case). On average, ASC-based procedures generated 0.547–1.026 kg of procedural waste; across both sites, waste output was meaningfully lower than published hospital-based estimates of 2–3 kg per case. Conclusion: ASCs generated substantially less waste per GIE compared to hospitals as most cases produce under half the reported hospital volume. Extrapolating nationally, a 10% shift in GIEs (2.2M procedures) from hospitals to ASCs could prevent 3.33–5.55M kg of medical waste and reduce CO₂ emissions by 2.33–3.89M kg. These findings highlight the potential environmental benefits of shifting endoscopic care to ASCs. Future work should further assess the impact of shifting endoscopy services to ASCs, including waste from perioperative care and the financial implications for practices and surgery centers.