463 Single-use Products and Plastics Contribute Significantly to Surgical Waste and the Carbon Footprint of Tonsillectomies in the United Kingdom

Aim Tonsillectomy is the fifth highest volume surgical procedure in England. The aims of this study were to characterise the cost, waste, and carbon footprint of equipment used in tonsillectomies at our Trust. Method A series of tonsillectomies were observed at three sites in our Trust. Details of the equipment were prospectively collected. This included: item and packaging materials; the quantity and reusability of items opened, used, and wasted; and the weight of recyclable, non-recyclable, and clinical waste produced per tonsillectomy. Reusable instrument trays were excluded from cost analysis. Overall carbon footprint was reported in carbon dioxide equivalents (CO2e) and calculated with published estimates of carbon emissions from individual items’ cradle-to-gate production, sterilisation, and waste streams. Results 20 tonsillectomies were included for analysis. The mean cost of tonsillectomy equipment was 137.75 GBP. 378 items were recorded in total – 70.5% were single-use, of which 91.6% were either composed of, or packaged in, plastic. The mean carbon footprint of the equipment was 6.78kg CO2e per tonsillectomy. 3.93kg CO2e came from single-use items, with 0.11kg CO2e from unused equipment. The incineration of clinical waste (mean weight 0.74kg) caused an additional 0.79kg CO2e of emissions per tonsillectomy. Conclusions Single-use equipment represented a significant carbon hotspot in tonsillectomies performed at our Trust. Reusable alternatives exist for many single-use items, and we suggest these be included in autoclavable sets to maximise reusability and minimise both cost and waste in operating rooms. These adjustments may lower emissions from their use and incineration, thus improving sustainability in surgery.