Waste Generation in Pediatric Orthopaedic Hardware Removal Surgery

Background: Removal of hardware (ROH) represents the third most common procedure performed by pediatric orthopaedic surgeons. When indicating patients, surgeons must balance the benefits of ROH against its burdens, including patient risk, cost, access, and waste. This study aims to quantify and characterize the waste generated in pediatric ROH surgery to better understand how it contributes to healthcare waste and associated impacts on patient and population health. Methods: A total of 10 pediatric ROH cases were audited at a tertiary care pediatric hospital between January and May 2025. All intraoperative waste was collected, categorized, and weighed. Waste was classified as unused, used but not visibly soiled, or used and visibly soiled. The presence or absence of recycling or other disposal labels was recorded. Waste was evaluated by case and collectively to assess trends, with subgroup analysis performed by waste stream, labeling, and usage. Results: An average of 6.8 kg of solid waste was generated per case, with top contributors being drapes (1.2 kg) and hard plastics (1.14 kg). Waste ranged from 5.3 to 8.1 kg per case. Only 11% (0.24 kg) of plastic waste items included recycling labels, while 7.76 kg of waste went unused (ranging from 5% to 22% of waste per case). Analysis of inter-surgeon variation identified gown and drape quantities as potential targets for waste reduction. Conclusions: Pediatric ROH generates significant waste and cost. Expanding these findings to ROH generally, annual projected waste attributable to ROH in pediatric orthopaedic patients would exceed 450,000 pounds in the United States each year. Landfill waste reduction may be significantly facilitated by greater inclusion of clear recycling labels by manufacturers, regular revision of procedure packs, and avoidance of excessive draping. Surgeons should strive to balance potential harms and surgical risks with the benefits of ROH in each case to promote high-value care. Key Concepts: (1)Pediatric hardware removal surgeries generate significant intraoperative waste, averaging 6.8 kg per case.(2)Over 13% of discarded materials go unused, suggesting that a portion of waste is excessive and unnecessary to the provision of patient care.(3)Only 11% of plastic waste was observed to have recycling labels, underscoring logistical hurdles to appropriately sorting operating room waste.(4)Extrapolated nationally, pediatric ROH procedures are estimated to contribute more than 450,000 pounds of waste annually in the United States, raising important considerations for high-value, sustainable care at scale.(5)Interventions such as clearer labeling, pack optimization, materials innovation, and re-evaluation of procedural indications could meaningfully reduce environmental and financial burdens at scale. Level of Evidence: Level II.