Do single-use medical devices containing biopolymers reduce the environmental impacts of surgical procedures compared with their plastic equivalents?

Abstract

Background While petroleum-based plastics are extensively used in health care, recent developments in biopolymer manufacturing have created new opportunities for increased integration of biopolymers into medical products, devices and services. This study compared the environmental impacts of single-use disposable devices with increased biopolymer content versus typically manufactured devices in hysterectomy. Methods A comparative life cycle assessment of single-use disposable medical products containing plastic(s) versus the same single-use medical devices with biopolymers substituted for plastic(s) at Magee-Women's Hospital (Magee) in Pittsburgh, PA and the products used in four types of hysterectomies that contained plastics potentially suitable for biopolymer substitution. Magee is a 360-bed teaching hospital, which performs approximately 1400 hysterectomies annually. Results There are life cycle environmental impact tradeoffs when substituting biopolymers for petroplastics in procedures such as hysterectomies. The substitution of biopolymers for petroleum-based plastics increased smog-related impacts by approximately 900% for laparoscopic and robotic hysterectomies, and increased ozone depletion-related impacts by approximately 125% for laparoscopic and robotic hysterectomies. Conversely, biopolymers reduced life cycle human health impacts, acidification and cumulative energy demand for the four hysterectomy procedures. The integration of biopolymers into medical products is correlated with reductions in carcinogenic impacts, non-carcinogenic impacts and respiratory effects. However, the significant agricultural inputs associated with manufacturing biopolymers exacerbate environmental impacts of products and devices made using biopolymers. Conclusions The integration of biopolymers into medical products is correlated with reductions in carcinogenic impacts, non-carcinogenic impacts and respiratory effects; however, the significant agricultural inputs associated with manufacturing biopolymers exacerbate environmental impacts.

Operating in a Climate Crisis: A State-of-the-Science Review of Life Cycle Assessment within Surgical and Anesthetic Care

“…Most notably, 11% of studies (n = 5) did not clearly state their selected LCA methodology, and 23% (n = 10) did not report which, if any, LCA standard was followed. Furthermore, nearly one-third of studies (30%, n = 13) did not report numerical impact values, opting instead to report results either graphically (Hu et al 2021;Ibbotson et al 2013;Ison and Miller 2000;Schmutz et al 2020;Sherman et al 2012;Tan and Lim 2021;Unger and Landis 2016) or relative to the most or least impactful case study (Campion et al 2012;Leiden et al 2020;Liang 2019;Stripple et al 2008;Thiel et al 2015;Unger et al 2017).…”

“…Twenty-eight studies assessed environmental impact contributions from equipment used in surgical settings, including a) general surgical items, such as gowns (Carre 2008;Van den Berghe and Zimmer 2011;, drapes (Vozzola et al 2018), scrubs (Mikusinska 2012), scissors (Ibbotson et al 2013), suction receptacles (Ison and Miller 2000), deep vein thrombosis (DVT) compression sleeves, pulse oximeters, LigaSure devices, harmonic scalpels, endoscopic trocars, arthroscopic shavers, scissor tips (Unger and Landis 2016); b) anesthetic equipment, such as anesthetic drug trays (McGain et al 2010), laryngeal mask airways (LMA; Eckelman et al 2012;Liang 2019), laryngoscope blades and handles (Sherman et al 2018), central venous catheter insertion kits (McGain et al 2012), and anesthetic equipment at two hospitals (McGain et al 2017); c) items specific to particular procedures or specialties, such as titanium alloy knee implants (Lyons et al 2021), custom packs used to deliver newborns (Campion et al 2015), ureteroscopes (Davis et al 2018), spinal fusion instrument sets (Leiden et al 2020), and single-use medical devices and products used during hysterectomy (Unger et al 2017); and d) items used in, but not specific to, surgery, such as personal protective equipment (masks, gloves, aprons, gowns, and face shields; Rizan et al 2021), surgical face masks (Allison et al 2020;Lee et al 2021;Schmutz et al 2020), medical gloves (Weisz et al 2020), urinary catheters (Stripple et al 2008), sharps containers (Grimmond and Reiner 2012;McPherson et al 2019), and vaginal specula (Donahue et al 2020).…”

AORN Position Statement on Environmental Responsibility

“…• selecting environmentally preferable reusable products, supplies, instrumentation, materials and equipment that meet environmental criteria over other options when they are equivalent in performance 27,28 ;…”

When Lca Applies to Health Service Industry

“…This study also conducted a comparison of assessments using LCA for single-use disposable medical products containing plastic versus the same single-use medical devices with biopolymers substituted for plastic at Magee-Women's Hospital (Magee) in Pittsburgh, PA. In addition, this study also compared the assessment of the products used in four types of contained plastic hysterectomies, potentially suitable for biopolymer substitution (Unger et al, 2017). This research seemed to be part of a study conducted by Thiel, 2015 in the same place.…”