Carbon footprint reduction in shoulder surgery by the rationalisation of single-use convenience packs.

Introduction: The United Kingdom National Health Service is responsible for a vast carbon footprint, with annual carbon dioxide emissions at over 25 million tonnes. Operating theatres contribute up to 25% of a hospital's emissions. Aims: To rationalise the composition of the single-use convenience packs in arthroscopic and open shoulder surgery, to reduce the annual carbon footprint. Methods: The individual material composition of all items in the single-use shoulder arthroscopy and open shoulder convenience packs was considered. The carbon footprint of each item was calculated by the application of best available cradle-to-gate emission factors. The items in the packs were then rationalised by consensus (of surgeons and scrub team). Two new standardised packs were designed. Results: In the 2022/2023 financial year, 296 arthroscopic and 191 open shoulder procedures were performed. The new rationalised open packs had between 3 and 18 fewer items, the new arthroscopic packs 7-8 fewer items. This will result in reduction of 108.9 kg of single use plastics, and an overall annual carbon footprint reduction of 643.8 kgCO Conclusion: Through a simple method of single-use convenience pack rationalisation, we have reduced the annual carbon footprint of shoulder surgery at our institution. The same methodology is being applied to all orthopaedic packs.