AUA 2024: Greening the Operating Room (GOR): High-Impact Initiatives Urologists’ Can Facilitate to Jumpstart a Program

( During the 2024 American Urological Association’s Quality Improvement and Patient Safety session, Dr. Divya Ajay presented an analysis of institutional initiatives focused on the impact of surgery and operating room processes on climate change. This retrospective analysis of strategies employed during the 2022 “Greening the Operating Room” (GOR) initiative illustrated the potential for healthcare facilities to significantly reduce their environmental footprint and operational costs by adopting sustainable practices.

Dr. Ajay explained that GOR initiatives were assessed retrospectively for the year 2022 using a sustainability dashboard that was maintained prospectively. This method enabled comprehensive monitoring and analysis of energy use, waste management, and greenhouse gas emissions associated with urological procedures at Memorial Sloan Kettering Cancer Center (MSKCC).

She delineated the key outcomes for GOR:

  1. Energy Savings: The initiatives led to a significant reduction in energy consumption, saving 1.8 million kWh of electricity.
  2. Reduction in Greenhouse Gas Emissions: There was a notable decrease in greenhouse gas emissions by 148%.
  3. Waste Management: The programs effectively avoided the generation of 150 tons of waste.
  4. Recycling Efforts: A total of 14,000 kilograms of single-use devices (SUDs) were recycled.

To reduce energy consumption, Dr. Ajay explained that MSKCC implemented computer power management software that ensured devices were turned off when not in use. Additionally, staff made a routine of switching off all operating room monitors and lights at the end of the day. Lighting systems were updated to energy-efficient LEDs and optimized their HVAC systems using CO2 sensors to adjust air exchanges based on room occupancy. These changes collectively contributed to a significant reduction in energy usage, saving 1.8 million kWh of electricity. 

Dr. Ajay reviewed that the GOR initiative also focused on waste reduction by standardizing case carts, which helped minimize unnecessary supplies. The shift from single-use plastics to reusable equipment played a crucial role in reducing waste generation. Moreover, the MSKCC implemented an extensive recycling program for single-use devices and other materials, such as sterile blue wraps. Additionally, they initiated donation programs for surplus medical equipment, further minimizing waste.

The management of anesthetic gases was another critical area of focus. MSKCC worked to reduce the usage of environmentally detrimental anesthetic gases such as Nitrous oxide and desflurane. They promoted the use of monitored sedation and regional anesthesia, which are less harmful to the environment compared to traditional anesthetic gases. 

According to Dr. Ajay, educational and collaborative efforts were integral to the success of the GOR initiatives. MSKCC installed recycling signage in every operating room and introduced color-coded systems for waste segregation to improve recycling efforts. Regular staff meetings ensured continuous communication and engagement with sustainability goals. Furthermore, the appointment of sustainability champions among the operating room staff and other stakeholders helped to lead and synchronize the efforts, ensuring everyone was aligned towards the common goal of reducing environmental impact. 

These comprehensive strategies not only highlighted the potential for significant environmental benefits but also demonstrated the cost reductions achievable through thoughtful and coordinated sustainability initiatives in healthcare settings. 


Presented by: Divya Ajay, MD, MPH, Memorial Sloan Kettering Cancer Center, New York, NY

Written by: Ruchika Talwar, MD, Urologic Oncology Fellow, Vanderbilt University Medical Center, during the 2024 American Urological Association (AUA) Annual Meeting, San Antonio, TX, Fri, May 3 – Mon, May 6, 2024.