Understanding the Environmental Footprint of Perioperative Care

Perioperative care encompasses the period before, during, and after surgery, involving a complex array of resources from anesthesia gases to single-use instruments and energy-intensive lighting and climate control in operating rooms (ORs). Globally, ORs account for a disproportionate share of healthcare's environmental impact. Studies show that ORs consume 3 to 6 times more energy per square foot than other hospital areas and generate 20% to 30% of a hospital's total waste. This waste includes plastics, pharmaceuticals, and biohazards, much of which ends up in landfills or incinerators, releasing greenhouse gases like carbon dioxide (CO2) and methane.

In terms of carbon emissions, a single surgical procedure can produce between 28.49 kg and 505.1 kg of CO2 equivalents, with medical devices and consumables being the largest contributors. Anesthesia gases, such as desflurane and nitrous oxide, are particularly potent, with global warming potentials thousands of times higher than CO2. These potent greenhouse gases (GHGs) escape into the atmosphere during procedures, exacerbating climate change, which in turn affects public health through extreme weather, disease spread, and resource scarcity.

UAE's Ambitious Net Zero 2050 Mandate and Healthcare's Role

The United Arab Emirates (UAE) has positioned itself as a global leader in sustainability with its Net Zero by 2050 strategic initiative, launched in 2021. This commitment aims to achieve balance between GHG emissions produced and those removed from the atmosphere by 2050, through clean energy, circular economy principles, and sector-wide decarbonization. Healthcare, responsible for about 4-5% of national emissions in many countries, is a key focus. In the UAE, initiatives like the Department of Health - Abu Dhabi's green hospital guidelines and the Ministry of Health and Prevention's (MoHAP) carbon footprint analysis project underscore this priority.

Emirates Health Services (EHS) has implemented the Green Patient Care program, achieving a 12% reduction in carbon emissions through AI monitoring and staff training. Hospitals are adopting green parking for electric vehicles and waste minimization strategies. However, perioperative care—a high-impact area—lacks tailored national strategies, creating a gap that the recent Cureus paper seeks to address.

The 'Green Scalpel' Paper: A Timely Call to Action

Published on March 30, 2026, in Cureus, "The Green Scalpel: Aligning United Arab Emirates Perioperative Care With the National Net Zero 2050 Mandate" by N. Gadalla and A. Fahim reviews 37 publications to highlight ORs' outsized environmental footprint and proposes a roadmap for UAE-specific sustainability.Read the full paper here The authors argue that while UAE healthcare is world-class, its ORs mirror global issues: high energy use, waste generation, and GHG emissions from volatile anesthetics.

The paper emphasizes multidisciplinary collaboration, evidence-based interventions, and alignment with national goals. It positions the "Green Scalpel" as an achievable vision through practical steps like waste audits and low-carbon procurement, without compromising patient safety.

Key Challenges Identified in UAE Perioperative Settings

In the UAE, rapid healthcare expansion has amplified OR resource demands. Challenges include limited waste segregation data, reliance on single-use plastics, high-flow anesthesia practices, and energy-intensive HVAC systems in hot climates. The paper notes the absence of routine carbon footprint audits in UAE hospitals, unlike in the UK or US where such metrics drive change.

Cultural factors, supply chain dependencies on imports, and regulatory gaps further hinder progress. For instance, pharmaceutical waste from expired sterile packs contributes significantly, as does the 24/7 operation of ORs requiring constant cooling.

Evidence-Based Interventions for Greener ORs

The paper outlines interventions proven globally. Low-flow anesthesia (≤0.5-1 L/min fresh gas flow) can reduce GHG emissions by 40-75% without affecting outcomes. Reusable instruments over disposables cut waste by up to 65% and costs similarly.

• Switch to less potent anesthetics like sevoflurane over desflurane.
• Implement closed-loop gas scavenging systems.
• Optimize OR schedules to minimize idle energy use.
• Adopt LED lighting and motion sensors.

Waste management hierarchies—reduce, reuse, recycle—are central, with segregation at source preventing 50% of clinical waste from incineration.

UAE Initiatives Paving the Way

EHS's sustainability projects include AI-driven emission tracking across facilities, achieving measurable reductions. Hospitals like Sheikh Shakhbout Medical City promote green buildings beyond structures, focusing on operations. MoHAP's carbon footprint project at Arab Health 2024 analyzed UAE hospitals, revealing opportunities in procurement and energy.Learn more about the project

PureHealth's net-zero by 2040 pledge accelerates sector-wide momentum, aligning with UAE Energy Strategy 2050.

Global Case Studies Inspiring UAE Progress

The UK's Green Surgery Report details OR waste reduction via supplier engagement and reusable kits, saving £millions annually. In the US, Practice Greenhealth's Greening the OR initiative has hospitals like UPMC cutting energy 20% through shutdown checklists. Australia's barriers study highlights staff education overcoming resistance to low-flow practices.

These models, adaptable to UAE's context, show ROI: sustainability often pays for itself via cost savings on supplies and energy.

Stakeholder Perspectives and Multidisciplinary Collaboration

Surgeons, anesthesiologists, nurses, and procurement teams must collaborate. The paper stresses training programs, like EHS's, to build awareness. Policymakers can incentivize via green procurement mandates. Experts note cultural shifts: viewing sustainability as core to Hippocratic "do no harm," extending to planetary health.

In UAE, universities like UAE University and Khalifa University can lead research on local waste audits and climate-resilient OR designs.

Measuring Success: Metrics, Audits, and Future Outlook

Success metrics include kg CO2e per procedure, waste diversion rates, and energy kWh/sq m. Regular audits, as recommended, enable benchmarking. By 2030, UAE healthcare aims 20% emission cuts; Net Zero 2050 requires scaling perioperative efforts.

Future: tech like AI-optimized HVAC, biodegradable sutures, and circular supply chains. The Green Scalpel positions UAE as a regional leader in sustainable surgery.

Photo by Mansi Telharkar on Unsplash

Actionable Insights for UAE Healthcare Leaders

• Conduct OR waste audits quarterly.
• Train staff on low-flow anesthesia protocols.
• Partner with suppliers for reusable alternatives.
• Integrate sustainability KPIs into hospital accreditation.

Implementing these fosters resilient, patient-centered care amid climate challenges.