BACKGROUND The healthcare sector in the United States has increased its greenhouse gas emissions by 6% since 2010 and today has the highest per capita greenhouse gas emissions globally. Assessing the environmental impact and material use through the methods of life cycle assessment (LCA) and material flow analysis (MFA) of healthcare procedures, products, and processes can aid in developing impactful strategies for reductions, yet such assessments have not been performed in orthopaedic surgery. We conducted an LCA and an MFA on an ACL reconstruction (ACLR). The ACLR served as a test case on the assumption that lessons learned would likely prove relevant to other orthopaedic procedures. QUESTIONS/PURPOSES (1) What are the life cycle environmental impacts of ACLR? (2) What is the material flow and material circularity of ACLR? (3) What potential interventions would best address the life cycle environmental impacts and material circularity of ACLR? METHODS First, we conducted an LCA according to International Organization for Standardization standards for quantifying a product's environmental impact across its entire life cycle. One result of an LCA is global warming potential measured in carbon dioxide equivalent (CO2eq), or carbon footprint. Second, we conducted an MFA of ACLR. Material flow analyses are used to quantify the amount of material in a determined system by tracking the input, usage, and output of materials, allowing for the identification of where materials are consumed inefficiently or lost to the environment. To contextualize the MFA, we calculated the material circularity indicator (MCI) index. This is used to measure how materials are circulating in a system and to evaluate the extent to which materials are recovered, reused, and kept within the economic loop rather than disposed of as waste. These three methods are widely used in other fields, especially engineering, but are more limited in healthcare research. Data collection and observations of ACLRs were made during ACLRs at the University of Pittsburgh Medical Center Bethel Park Surgical Center in Pittsburgh, PA, USA, between 2022 and 2023. Three sessions of data collection and observations were needed due to complexity and scheduling, ranging from understanding the sterilization procedures to weighing individual items. Data encompassing electricity usage; surgical equipment type; the use of heating, ventilation, and air conditioning (HVAC) systems; the production and reuse of reusable instruments and gowns; and the production and disposal of single-use surgical products were collected. Following data collection, we conducted the LCA and the MFA and then calculated the MCI for a representation of a single ACLR. To identify strategies to reduce the environmental impact of ACLR, we modeled 11 possible sustainability interventions developed from prior work and compared those strategies against the impact of the baseline ACLR. RESULTS Our results show that the ACLR generated an estimated life cycle greenhouse gas emissions of 47 kg of CO2eq, which is analogous to driving a typical gasoline-fueled passenger vehicle for 120 miles. The total mass of all products for one ACLR was estimated at 12.73 kg, including 7.55 kg for disposable materials and 5.19 kg for reusable materials. Concerning material circularity, ACLR had a baseline MCI index of 0.3. Employing LCA for the carbon footprint and the MCI for 11 sustainability interventions indicated the potential to reduce greenhouse gas emissions by up to 42%, along with an increase in circularity (how materials are recovered, reused, and kept within the economic loop rather than disposed of as waste) of up to 0.8 per ACLR. Among the most impactful interventions are the reduction in the utilization of surgical pack products, reutilization of cotton towels and surgical gowns, maximization of energy efficiency, and increasing aluminum and paper recycling. CONCLUSION ACLR has a substantial carbon footprint, which can meaningfully be reduced by creating a minimalist custom pack without material wastage, reusing cotton towels, and maximizing recycling. Combining LCA, MFA, and MCI can provide a thorough assessment of sustainability in orthopaedic surgery. CLINICAL RELEVANCE Orthopaedic surgeons and staff can immediately reduce the environmental impact of orthopaedic procedures such as ACLR by opening fewer materials-via makingminimalist packs and only opening what is needed in the operating room-and by incorporating more reusable materials such as towels. Larger scale medical center changes, such as implementing recycling programs and installing energy-efficient systems, also can make a meaningful difference in reducing environmental impact.

中文翻译：

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如何衡量和减少骨科手术对环境的影响？使用前交叉韧带重建作为测试案例。


背景 自 2010 年以来，美国医疗保健行业的温室气体排放量增加了 6%，如今是全球人均温室气体排放量最高的行业。通过医疗保健程序、产品和流程的生命周期评估 （LCA） 和材料流分析 （MFA） 方法评估环境影响和材料使用有助于制定有影响力的减少策略，但此类评估尚未在骨科手术中进行。我们对 ACL 重建 （ACLR） 进行了 LCA 和 MFA。ACLR 作为一个测试案例，假设所吸取的经验教训可能被证明与其他骨科手术相关。问题/目的 （1） ACLR 的生命周期环境影响是什么？（2） ACLR 的物料流向和物料循环性是什么？（3） 哪些潜在的干预措施最能解决 ACLR 的生命周期环境影响和材料循环性？方法 首先，我们根据国际标准化组织的标准进行了 LCA，以量化产品在其整个生命周期中的环境影响。LCA 的一个结果是以二氧化碳当量 （CO2eq） 或碳足迹来衡量全球变暖潜能值。其次，我们进行了 ACLR 的 MFA。物料流分析用于通过跟踪材料的输入、使用和输出来量化确定系统中的材料量，从而识别材料消耗效率低下或流失到环境中的位置。为了将 MFA 置于上下文中，我们计算了材料循环指标 （MCI） 指数。 这用于衡量材料在系统中的循环方式，并评估材料被回收、再利用和保持在经济循环内而不是作为废物处理的程度。这三种方法广泛用于其他领域，尤其是工程学，但在医疗保健研究中受到更多限制。2022 年至 2023 年期间，在美国宾夕法尼亚州匹兹堡的匹兹堡大学医学中心伯特利公园外科中心进行 ACLR 期间，对 ACLR 进行了数据收集和观察。由于复杂性和时间安排，需要进行三次数据收集和观察，从了解灭菌程序到称量单个物品。包括用电量的数据;手术器材类型;供暖、通风和空调 （HVAC） 系统的使用;生产和再利用可重复使用的器械和防护服;并收集了一次性手术产品的生产和处置。数据收集后，我们进行了 LCA 和 MFA，然后计算了单个 ACLR 的表示的 MCI。为了确定减少 ACLR 对环境影响的策略，我们对根据先前工作开发的 11 种可能的可持续性干预措施进行了建模，并将这些策略与基线 ACLR 的影响进行了比较。结果我们的结果表明，ACLR 产生的生命周期温室气体排放量估计为 47 公斤二氧化碳当量，这相当于驾驶一辆典型的汽油燃料乘用车行驶 120 英里。一个 ACLR 的所有产品的总质量估计为 12.73 公斤，其中一次性材料为 7.55 公斤，可重复使用材料为 5.19 公斤。关于材料循环性，ACLR 的基线 MCI 指数为 0.3。 对碳足迹采用 LCA，对 11 项可持续性干预措施采用 MCI 表明，有可能将温室气体排放量减少多达 42%，同时循环性（材料如何被回收、再利用和保持在经济循环中，而不是作为废物处理）提高高达 0.8/ACLR。最具影响力的干预措施包括减少手术包产品的利用、棉毛巾和手术衣的再利用、最大限度地提高能源效率以及增加铝和纸张的回收。结论ACLR 具有大量的碳足迹，可以通过创建无材料浪费的极简定制包装、重复使用棉毛巾和最大限度地回收来有意义地减少碳足迹。结合 LCA、MFA 和 MCI 可以对骨科手术的可持续性进行全面评估。临床相关性 骨科医生和工作人员可以通过打开更少的材料（通过制作极简的包装并只打开手术室需要的材料）以及加入更多可重复使用的材料（如毛巾）来立即减少骨科手术（如 ACLR）对环境的影响。更大规模的医疗中心改造，例如实施回收计划和安装节能系统，也可以在减少环境影响方面产生有意义的影响。