Solid Waste and Associated Environmental Impact of WALANT Carpal Tunnel Release Performed Across Three Clinical Settings.

Abstract

Purpose: Carpal tunnel release (CTR) remains the most common hand and wrist surgery in the United States, with an estimated 500,000 procedures per year. The introduction of wide-awake local anesthetic, no tourniquet (WALANT) technique and use of a minor sterile field has allowed CTR procedures to be performed in a clinic setting. Our study aimed to quantify the solid waste and related emissions associated with WALANT CTR procedures performed in a hospital operating room, ambulatory surgical center, and clinic.

Methods: All WALANT unilateral CTRs performed by three fellowship-trained hand surgeons from the same hospital system were prospectively studied over a 6-month period. Data gathered were surgical venue (hospital operating room, ambulatory surgical center (ASC), or clinic) and weight of solid waste produced by material type. The carbon emissions associated with the production and disposal of this waste were calculated using emissions factors from the UK Government's Department for Energy Security and Net Zero.

Results: Over 43 cases, there were significant differences in solid waste production. The average waste generated was 4.6 kg in the hospital operating room, 2.6 kg in the ASC, and 0.7 kg in the clinic. Similarly, greenhouse gas emissions, denoted in equivalent amount of CO₂ (kgCO₂-eq) varied by site, with the operating room emitting 41.6 kg of CO2eq, the ASC 26.0 kg, and the clinic 8.3 kg on average.

Conclusions: Our research considers the environmental impact of the same procedure performed in different settings. Under our institution's current policies, the clinic setting is the most sustainable venue to perform CTR. This supports and replicates previous studies at other institutions.

Clinical relevance: Limiting the environmental impact of surgery is possible. Moving common hand surgeries such as CTR to the clinic may be a more efficient way to achieve improvements in environmental impact than changing hospital or ASC policies.