Abstract：
BACKGROUND: Orthopaedic surgery is culpable, in part, for the excessive carbon emissions in health care partly due to the utilization of disposable instrumentation in most procedures, such as rotator cuff repair (RCR). To address growing concerns about hospital waste, some have considered replacing disposable instrumentation with reusable instrumentation. The purpose of this study was to estimate the cost and carbon footprint of waste disposal of RCR kits that use disposable instrumentation compared with reusable instrumentation.
METHODS: The mass of the necessary materials and their packaging to complete a four-anchor RCR from four medical device companies that use disposable instrumentation and one that uses reusable instrumentation were recorded. Using the cost of medical waste disposal at our institution ($0.14 per kilogram) and reported values from the literature for carbon emissions produced from the low-temperature incineration of noninfectious waste (249 kgCO 2 e/t) and infectious waste (569 kgCO 2 e/t), we estimated the waste management cost and carbon footprint of waste disposal produced per RCR kit.
RESULTS: The disposable systems of four commercial medical device companies had 783%, 570%, 1,051%, and 478%, respectively, greater mass and waste costs when compared with the reusable system. The cost of waste disposal for the reusable instrumentation system costs on average $0.14 less than the disposable instrumentation systems. The estimated contribution to the overall carbon footprint produced from the disposal of a RCR kit that uses reusable instrumentation was on average 0.37 kg CO2e less than the disposable instrumentation systems.
CONCLUSIONS: According to our analysis, reusable instrumentation in four-anchor RCR leads to decreased waste and waste disposal costs and lower carbon emissions from waste disposal. Additional research should be done to assess the net benefit reusable systems may have on hospitals and the effect this may have on a long-term decrease in carbon footprint.
METHODS: Level II.
METHODS: The mass of the necessary materials and their packaging to complete a four-anchor RCR from four medical device companies that use disposable instrumentation and one that uses reusable instrumentation were recorded. Using the cost of medical waste disposal at our institution ($0.14 per kilogram) and reported values from the literature for carbon emissions produced from the low-temperature incineration of noninfectious waste (249 kgCO 2 e/t) and infectious waste (569 kgCO 2 e/t), we estimated the waste management cost and carbon footprint of waste disposal produced per RCR kit.
RESULTS: The disposable systems of four commercial medical device companies had 783%, 570%, 1,051%, and 478%, respectively, greater mass and waste costs when compared with the reusable system. The cost of waste disposal for the reusable instrumentation system costs on average $0.14 less than the disposable instrumentation systems. The estimated contribution to the overall carbon footprint produced from the disposal of a RCR kit that uses reusable instrumentation was on average 0.37 kg CO2e less than the disposable instrumentation systems.
CONCLUSIONS: According to our analysis, reusable instrumentation in four-anchor RCR leads to decreased waste and waste disposal costs and lower carbon emissions from waste disposal. Additional research should be done to assess the net benefit reusable systems may have on hospitals and the effect this may have on a long-term decrease in carbon footprint.
METHODS: Level II.
摘要：
背景：骨科手术是罪魁祸首，在某种程度上,对于医疗保健中过度的碳排放，部分原因是在大多数程序中使用一次性仪器，例如肩袖修复(RCR)。为了解决对医院废物日益增长的担忧，有些人考虑用可重复使用的仪器代替一次性仪器。这项研究的目的是估算与可重复使用的仪器相比，使用一次性仪器的RCR套件的废物处理的成本和碳足迹。
方法：记录了从四家使用一次性仪器和一家使用可重复使用仪器的医疗器械公司完成四锚RCR所需材料及其包装的质量。使用我们机构的医疗废物处理成本（每公斤0.14美元）和文献中报告的非感染性废物低温焚烧产生的碳排放值（249kgCO2e/t）和感染性废物（569kgCO2e/t），我们估计了每个RCR套件产生的废物管理成本和废物处置的碳足迹。
结果：四家商业医疗器械公司的一次性系统占783％，570%,1051%,478%,分别,与可重复使用的系统相比，更大的质量和浪费成本。可重复使用的仪表系统的废物处理成本平均比一次性仪表系统低0.14美元。使用可重复使用的仪器的RCR套件的处置对总体碳足迹的估计贡献平均比一次性仪器系统少0.37kgCO2e。
结论：根据我们的分析，四锚RCR中的可重复使用的仪器可降低废物和废物处理成本，并降低废物处理的碳排放量。应该做更多的研究来评估可重复使用系统可能对医院产生的净效益，以及这可能对碳足迹长期减少的影响。
方法：二级。
方法：记录了从四家使用一次性仪器和一家使用可重复使用仪器的医疗器械公司完成四锚RCR所需材料及其包装的质量。使用我们机构的医疗废物处理成本（每公斤0.14美元）和文献中报告的非感染性废物低温焚烧产生的碳排放值（249kgCO2e/t）和感染性废物（569kgCO2e/t），我们估计了每个RCR套件产生的废物管理成本和废物处置的碳足迹。
结果：四家商业医疗器械公司的一次性系统占783％，570%,1051%,478%,分别,与可重复使用的系统相比，更大的质量和浪费成本。可重复使用的仪表系统的废物处理成本平均比一次性仪表系统低0.14美元。使用可重复使用的仪器的RCR套件的处置对总体碳足迹的估计贡献平均比一次性仪器系统少0.37kgCO2e。
结论：根据我们的分析，四锚RCR中的可重复使用的仪器可降低废物和废物处理成本，并降低废物处理的碳排放量。应该做更多的研究来评估可重复使用系统可能对医院产生的净效益，以及这可能对碳足迹长期减少的影响。
方法：二级。
