Environmental Discourse in Orthopedic Surgery Publications: Are we on par with other surgical subspecialties?

Author(s): Olivia L Brand, Laura L Bellaire, Gretchen Maughan-Egbert, Daisy Lookinland, Brittany N Garcia

Aims: The U.S. health system produces 8%-10% of national greenhouse gas (GHG) emissions with operating rooms (ORs) being the most resourceintensive area [1,2]. Orthopedic surgical cases generate significant waste from disposable procedure packs, large instrument trays, and single use instruments [2]. This study evaluates publishing trends in the top five journals with the highest impact factor within nine surgical subspecialties related to environmental stewardship and planetary health, highlighting challenges and opportunities for future research.

Methods: Using the Journal of Citation Reports (JCR) Database, the five highest impact factor (IF) journals 9 surgical subspecialties were identified. Publications were reviewed over a 25-year period (1999-2024). Articles including environment and one other key word [environment, environmental impact, sustainability, carbon footprint, GHG emissions, greenhouse, climate, recycling and waste] underwent initial review. Articles were categorized and identified as primary research or review articles. Results were tabulated as n, percentages, and means.

Results: Of 4,263 articles reviewed, 131 were included in the final analysis. Publications on environmental impact and sustainability surged beginning in 2019. Anesthesiology had the greatest number of publications (47/131), plastic surgery had the least (2/131) and orthopedic surgery had the second fewest publications (4). Most publications (78/131 or 60%) were review articles. Average impact factor was highest in general surgery publications (14.1) and fifth highest in orthopedic surgery (5.1). Waste audits were the most common article classification (21%) followed closely by anesthetic gases (17%).

Conclusion: While orthopedic surgery is a high-volume specialty and generates significant waste and GHG emissions, it falls behind other subspecialties in publishing literature related to the environment. Public awareness of climate change has grown significantly, but the medical profession has not kept pace. The future of health systems requires a better understanding of how to protect planetary health to avoid future losses to patient and population health and well-being.