Theatre waste production and the carbon emissions from tonsillectomy surgery
Original Article

Theatre waste production and the carbon emissions from tonsillectomy surgery

Marina N. Cavada1,2 ORCID logo, Scott McAlister3,4,5, Raymond Sacks2,4, Catherine S. Birman2,4,6,7

1Department of Otolaryngology, Sydney Adventist Hospital, Sydney, NSW, Australia; 2Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; 3Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia; 4Faculty of Medicine and Health Sciences, The University of Sydney, Sydney, NSW, Australia; 5Wiser Healthcare, The University of Sydney, Sydney, NSW, Australia; 6Department of Otolaryngology, Head and Neck Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; 7Department of Paediatric Otolaryngology, Children’s Hospital at Westmead, Sydney, NSW, Australia

Contributions: (I) Conception and design: MN Cavada, CS Birman, R Sacks; (II) Administrative support: MN Cavada; (III) Provision of study materials or patients: CS Birman; (IV) Collection and assembly of data: MN Cavada; (V) Data analysis and interpretation: MN Cavada, S McAlister; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors.

Correspondence to: Marina N. Cavada, MD, FRACS. 12/25-29 Hunter St, Hornsby NSW 2077, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; Department of Otolaryngology, Sydney Adventist Hospital, Sydney, NSW, Australia. Email: marinacavada@gmail.com.

Background: Healthcare waste contributes significantly to carbon dioxide emissions which are known to be causing climate change and negatively impacting health by affecting clean air, drinking water, nutritious food supply, and safe shelter. Tonsillectomy is one of the most common surgical procedures performed in Australia and New Zealand and its impact on the environment has not been measured. The aim of this study is to evaluate the amount of waste generated by a tonsillectomy procedure, assess the carbon dioxide equivalents (CO2e) emissions, and discuss sustainable alternatives to reduce the environmental impact of surgery moving forward.

Methods: A prospective case study of waste produced by a single tonsillectomy procedure in an Australian private hospital was conducted. Disposable drapes and surgical preformed sterile packs were used along with recyclable instrument trays. The waste generated by the surgery and the anaesthetics were collected, collated, weighed, and divided into non-recyclable and recyclable items. Items were grouped according to their material type. The weight and carbon emissions life cycle assessment were performed.

Results: A tonsillectomy procedure generated 2.117 kg of waste; 1.253 kg (59%) of non-recyclable waste and 0.864 kg (41%) of recyclable waste. From the total waste of a tonsillectomy procedure the median dioxide carbon emissions were 25.905 kg CO2e (approximately equivalent to 65.3 kilometers driven by an average car).

Conclusions: Tonsillectomy in a modern Australian hospital, with the move to disposable plastic theatre drapes, gowns, bowls, equipment, generates a significant amount of waste of approximately 95,594.10 kg of solid waste and 1,178,993 kgCO2e per year in Australia. Reducing, reusing, and recycling strategies are required moving forward to reduce the impact of ear, nose and throat (ENT) and head and neck surgery on the environment without negatively affecting quality of care and safety to patients and health care workers.

Keywords: Otolaryngology; medical waste; recycling; environmental assessment; carbon footprint

Received: 08 March 2025; Accepted: 18 September 2025; Published online: 16 January 2026.

doi: 10.21037/ajo-25-25

Introduction

The healthcare system in Australia is one of the top ten healthcare carbon dioxide (CO2) emitters in the world (1). Healthcare contributed 7.2% [68% confidence interval (CI): 5.1–9.3%] of Australia’s total carbon dioxide equivalents (CO2e) emissions in 2014–2015, and 5% in 2024 (2,3). These emissions in turn affect health either directly, due to extreme weather events including flooding, heatwaves, bush fires, droughts, and storms (2,4), and indirectly due to malnutrition, lower respiratory diseases, and infectious diseases (5).

Climate change is expected to cause approximately 250,000 deaths between 2030 and 2050 from malnutrition, malaria, diarrhoea, and heat stress. The Lancet Commission on Health and Climate Change concluded that climate change is the biggest global health threat of the 21st century (6), while the World Health Organisation (WHO) considers climate change an urgent, global health challenge that requires prioritizing actions to reduce CO2 emissions (7).

In the United Kingdom (UK), the healthcare sector accounts for 4% of the CO2e emissions. The CO2e footprint of the National Health Service (NHS) in England is estimated at 20 million tonnes of greenhouse gases per year and accounts for 25% of all public sector emissions in the UK (8). In the United States of America (USA), healthcare sector accounts for 10% of CO2e emission (9). In the USA, hospitals alone generate more than 7,000 tons of waste per day (10) and 7 million tonnes per year (11).

The carbon emissions generated from Australia’s healthcare in 2014–2015 was approximately 35,772 kilotonnes CO2e (68% CI: 25,398–46,146), with 44% of healthcare CO2 emissions arising from acute hospital care, 19% from pharmaceuticals, and 4% from general practice. Public hospitals contributed to 34% of the CO2e emissions compared to 10% from private hospitals (2).

The level of engagement with sustainable practices varies considerably among countries. The UK’s NHS, aims to become the first national health system to commit to producing net zero carbon emissions by reducing CO2e emissions by 80% by 2030 and achieve net zero by 2040 (12). In Australia, the state of New South Wales’s Climate Change Policy Framework has set targets for net-zero CO2 emissions by 2050 (13). However, there is currently no target to reduce emissions in healthcare (14).

Several studies have been published measuring the carbon footprint of medical devices and procedures in the Australian healthcare sector, however, the CO2e emissions from ear, nose and throat (ENT) procedures in Australia has not been assessed (2,15-19). Tonsillectomy is one of the most common surgical procedures performed in Australia and New Zealand. Between 1 July 2000 and 30 June 2022, there were 1,039,270 tonsillectomy procedures recorded in Australia (20,21).

The aim of this study is to evaluate the amount of waste generated by a tonsillectomy procedure, assess the CO2e emissions, and discuss sustainable alternatives to reduce the environmental impact of surgery moving forward.

Methods

A prospective case study of waste produced by a single tonsillectomy procedure was conducted in January 2022 at a private hospital in Sydney, Australia. The requirement for ethics approval or informed consent was waived by the Human Research Ethics and Governance Office of the Royal Prince Alfred Hospital (Sydney, Australia) as no human participants were involved in this study. The study is reported according to the STROBE reporting guidelines (available at https://www.theajo.com/article/view/10.21037/ajo-25-25/rc).

The tonsillectomy technique used in this study was a harmonic scalpel extracapsular dissection, with bipolar diathermy haemostasis. The instruments and materials used for a tonsillectomy consist of a standard head and neck sterile procedure pack (Medline, Marsden Park, Australia) which contains 35 items (Table 1) and a sterile pre-packaged metal instrument tray for tonsillectomy procedures. The waste generated by the procedure was collected, collated, weighed, and divided into recyclable and non-recyclable items. Additionally, the items not used from the standard head and neck sterile procedure pack were separated, collated, and weighed.

Table 1

Standard head and neck sterile procedure pack (Medline, Marsden Park, Australia) used in a tonsillectomy procedure

Contents Used Quantity Weight (kg) Cost (AUD$)
Instrument wipe 73 mm × 73 mm Yes 1 0.002 2.06
Surgical blade #15 No 1 0.001 0.22
Drawing up needle 18 G × 38 mm with bevel Yes 1 0.001 0.02
Needle 25 G × 38 mm Yes 1 0.001 0.02
Bag re-closable vented No 1 0.007 0.02
Glassine bag No 1 0.018 0.95
Label sheet 16 UP minor pack Yes 1 0.006 0.95
Medicine cup 60 cc Yes 2 0.008 0.04
Needle counter 20 count No 1 0.041 2.21
Back table cover 63×94 H/D Yes 1 0.385 3.12
Kidney dish yellow No 1 0.032 0.19
Quiver D loop handle Yes 1 0.035 1.35
Towel cotton blue No 2 0.116 0.94
Gallipot clear Yes 2 0.015 0.34
Kidney dish blue No 3 0.092 0.56
Gauze swab 10 mm × 10 mm Yes 5 0.017 0.21
Syringe 10 mL Yes 1 0.010 0.07
Wrap Gemini 137 cm × 137 cm Yes 1 0.036 0.56
Skin marker with ruler/label No 1 0.007 1.04
Gown advanced XL unreinforced Yes 1 0.159 2.35
EENT slip drape Yes 1 0.418 6.58
Yankauer suction handle Yes 1 0.015 0.89
Suction tubing 6 mm × 4 mm special soft Yes 1 0.214 3.90
Drape sheet medium Yes 2 0.312 2.43

EENT, ear, eye, nose and throat; H/D, height/depth; XL, extra large.

All items were grouped according to their material type. The non-recyclable items from the surgical team included contaminated materials, used personal protective equipment, and cotton towels. The recyclable items included uncontaminated materials, and were further divided into paper, soft plastic, sterilization wrap, and polypropylene plastic containers. Biological waste, sharp materials, reusable items, and gas waste from anaesthetics were not included, as our objective was to concentrate on the single-use items employed by the surgical team. All items were weighed separately as per material type using a Micro Digital SW30 scale (@weight Scales, Moorabbin, Victoria, Australia) which measured the weight in kilograms (kg).

The cost of each item from the standard head and neck sterile procedure pack (Medline, Marsden Park, Australia) was obtained from the hospital where the procedure was performed. The aim was to calculate the overall cost and determine the potential saving for the hospital by reducing the number of items in the tray.

A life cycle assessment (LCA) of each item was performed based on the International Organizations for Standardization standard ISO14040/44. LCA estimates emissions from all parts of an item life cycle (‘cradle-to-grave’) including raw material extraction, manufacture, and disposal. The functional unit was a sterile head and neck pack suitable for a tonsillectomy. The system boundary showing all inclusions is shown in Figure 1. Impacts were modelled using SimaPro 9.4 LCA software (PRé Sustainability, Amersfoot, The Netherlands), with carbon emissions of individual materials being obtained from the APOS version of the ecoinvent 3.6 APOS database (ecoinvent, Zurich Switzerland). Impact assessment was performed using SimaPro’s 2021 Intergovernmental Panel on Climate Change (IPCC) 100-year global warming potentials (22-24).

Figure 1 System boundary showing the life cycle assessment inclusions. PVC, polyvinyl chloride.

The primary outcome was the total amount of waste produced from a tonsillectomy procedure in kg. The secondary outcome was carbon emissions in kg CO2e, and the amount of waste that could be reduced as well as the cost that could be saved by reducing the sterile procedure pack.

Results

The items in a standard head and neck sterile procedure pack (Medline, Marsden Park, Australia) are shown in Table 1. The total waste generated by a single tonsillectomy procedure was 2.117 kg. The weight of the non-recyclable waste was 1.253 kg (59%), and 0.864 kg (41%) was recyclable. The non-recyclable items from the surgical team included disposable gowns used by the surgeon and the scrub nurse, contaminated disposable drapes, cotton towels, gloves, bluey, monopolar diathermy pad, harmonic scalpel tonsillectomy instrument, white sucker, four syringes, long nozzle for topicalization of the vocal cords, endotracheal tube, Guedel airway, and four electrocardiogram dots. The recyclable items were divided into paper, soft plastic, sterilization wrap, and polypropylene plastic containers. The carbon impact of the surgical equipment used in a tonsillectomy procedure is 25.9 kg CO2e (Table 2).

Table 2

Life cycle assessment of the waste produced by a tonsillectomy procedure

Item Impact (kg CO2e)
Sterile head and neck pack 15
Drapes—landfill 2.9
Towels—landfill 2.8
Sterile pair latex gloves 1.6
Sterilisation wrap 1.1
Plastic containers 0.7
Soft plastic—landfill 0.6
Rediwipe 0.5
Nitrile pair gloves 0.4
X-ray—bluey 0.2
Paper—recycled 0.1
Terumo 20 cc syringe 0.04
Terumo 10 cc syringe 0.03
Terumo 3 cc syringe 0.01
Pen/ruler 0.001
Total 25.9

CO2e, carbon dioxide equivalents.

From the premade sterile pack, 8 (33%) of the items were not used and were discarded with the general contaminated waste at the end of case (Table 1). This shows that 0.314 kg could be reduced from routine waste and 6.13 Australia dollars (AUD$) could be saved by the hospital per tonsillectomy procedure.

Discussion

Our analysis shows the waste from a tonsillectomy procedure, which is one of the most common surgical procedures, results in a 2.1 kg of disposed waste, 15% of which was not used, and other components could be recycled. This has a huge impact in Australia and NZ as using 2021–2022 Australian figures for annual tonsillectomies of 45,521 (25), this waste results in 95,594.10 kg of solid waste and 1,178,993 kg CO2e produced per year. In comparison, a UK study reported 41 kg CO2e per tonsillectomy with the difference reflecting additional LCA factors, such as pharmaceuticals, surgical instrument decontamination, and utilities, which were not included in our analysis (26).

Medical waste has increased dramatically over the past 30 years, with healthcare facilities worldwide generating more waste than ever before. This surge correlates with the growth of the global population and the expansion of medical facilities (27). The increase in volume of waste produced by operating theatres and hospitals is partly due to the switch from reusable devices to single-use plastic devices from the 1980s amid concerns about blood-borne diseases (28).

According to WHO, cutting CO2 emissions is essential to protect health and reduce its impact in the next decades (7). In Australia, climate change has already been directly affecting health through bush fires across the country, droughts, extreme heat, and flooding. Health care professionals advocate for global strategies to address climate change and also can seek to reduce the CO2 emissions from their own medical establishments and practices (29). Sustainable healthcare aims to provide optimal care for patients without compromising it in the future (4) by implementing the 3Rs—reducing purchasing of resources, reusing resources, and recycling resources where possible (12,30), which can reduce costs and waste and improve health (6). Avoiding unnecessary materials and supplies should be prioritized.

A study in the USA showed that redesigning surgical kits used for adenotonsillectomies reduced 1.48 tonnes of waste annually between a children’s hospital and an ambulatory surgery setting (31). A low-waste setup implemented in an Australian institution demonstrated a waste reduction of over 60%, with an average decrease of 1.114 kg in waste per adenotonsillectomy (19). Similarly, a study including 46 tonsillectomies identified that from the standard tonsillectomy tray containing 38 pieces, 9 pieces were never used and the removal of unused reusable instruments resulted in an estimated total reduction of 594 g of CO2e and a saving of €9.63 per operation (32). This study showed that 15% of the waste generated by a tonsillectomy could have been reduced by redesigning the single pack used in the procedure.

Numerous interventions have reduced operating theatres’ waste such as the replacement of disposable surgical items, such as basins and drapes, with reusable ones and implementing the recycling of all intravenous bags (10). A review of five studies comparing reusable versus single-use surgical gowns concluded that using reusable gowns demonstrated a reduction of at least 50% in environmental footprints (33). Similarly, the carbon footprint of reusable laryngeal mask airways (LMAs) was two-thirds that of the single-use LMAs (34).

For recycling, in healthcare the recycling of medical waste has challenges. Infection control concerns mean clinical waste or soiled items are unable to be recycled. Of the remaining material, there are both financial and technical challenges (35). In Australia, the most commonly recycled material is PVC from saline bags (12), along with Kimguard polypropylene wrap, although the recycling of Kimguard comes at a greater financial cost to health services compared to landfill (36).

While drapes have traditionally been used in tonsillectomy to maintain sterility and protect staff, their routine use is being reconsidered. Evidence supporting draping in clean-contaminated procedures like tonsillectomy is limited. In the UK, there is a shift toward minimalist or reusable draping protocols, driven by environmental concerns, cost savings, and lack of strong evidence that full draping reduces infection rates (37). Guidelines from WHO emphasize barrier effectiveness over whether materials are disposable or reusable (38). Practice now varies by centre, with some omitting full drapes entirely in selected cases.

New sustainability guidelines developed through the Royal College of Surgeons of Edinburgh’s Future Leaders Programme in collaboration with ENT UK and the Infection Prevention Society, aim to reduce single-use items in ENT outpatient and operating room settings. Recommendations include using reusable instruments, limiting unnecessary gloves and aprons, adopting UV-C (Ultraviolet-C) light for decontamination, and switching to reusable scopes and surgical gowns (39). In operating rooms, strategies like optimising instrument trays, using tap water where appropriate, and avoiding volatile gases by using local anaesthesia help cut waste and emissions. These evidence-based practices promote long-term environmental sustainability in ENT care (40). LCA studies indicate that using reusable items saves money when compared to single-use equipment, however, the environmental impacts depend on the source of electricity for washing and sterilising reusable items. While a reusable item may be more expensive at the outset, the longevity of these items and the reduction in waste production is where the true value lies (41). It is important to consider that if items are unable to be recycled and instead are disposed of in landfill, plastics are advantageous compared to biodegradable materials such as bioplastics. This is due to biodegradable items producing methane in the anerobic conditions of landfill sites, with 1 kg of methane having the same global warming potential of 27 kg of CO2 (42).

Surgical technique also plays a significant role in determining the environmental impact of medical procedures. Variations in subtotal tonsillectomy techniques can lead to significant differences in carbon emissions. A comparative analysis revealed that specific methods, such as cold dissection, were associated with a lower carbon footprint compared to energy-based techniques, underscoring the importance of surgical decision-making not only for patient outcomes but also for environmental sustainability. Meiklejohn et al. showed that cold technique not only has less impact on the environment, but it is also more cost effectively compared to monopolar electrocautery, and coblation techniques (43).

Strategies to reduce the environment impact in healthcare are not limited to reducing purchasing of resources, reusing resources, and recycling resources. It also involves reducing carbon footprint of long patient stay, use of operative theatres, and healthcare travel. Current interventions include a shift towards day-case surgery and future areas for development include waterless scrub alternatives, waste-trapping technologies for anaesthetic gases and continuing investment in virtual healthcare (44).

The limitations of this study include the fact that only operating theatre waste was investigated, as there would be further perioperative waste from preadmission clinics, recovery and on the wards. The impacts of anaesthesia were not included in this analysis. The place of manufacture, and hence the carbon impacts of transport of the consumables could not be determined; however, one study has reported this impact to be minimal (45).

Conclusions

In conclusion, tonsillectomy is a very common surgical procedure in Australia and with the move to disposable plastic theatre drapes, gowns, bowls, equipment, this generates a significant amount of waste of approximately 95,594.10 kg of solid waste and 1,178,993 kg CO2e per year in Australia. Reducing the impact of surgery on the environment is urgently needed. Surgeons should become more conscious of their own consumption to creating a more sustainable surgical practice.

Acknowledgments

None.

Footnote

Reporting Checklist: The authors have completed the STROBE reporting checklist. Available at https://www.theajo.com/article/view/10.21037/ajo-25-25/rc

Data Sharing Statement: Available at https://www.theajo.com/article/view/10.21037/ajo-25-25/dss

Peer Review File: Available at https://www.theajo.com/article/view/10.21037/ajo-25-25/prf

Funding: None.

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://www.theajo.com/article/view/10.21037/ajo-25-25/coif). R.S. reports serving as a consultant for Medtronic and receiving payment for expert testimony from Avant Medical Protection Society. He also holds the positions of Vice President of the Royal Australasian College of Surgeons. The other authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The requirement for ethics approval or informed consent was waived by the Human Research Ethics and Governance Office of the Royal Prince Alfred Hospital (Sydney, Australia) because no human participants were involved in this study.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

  1. ARUP. Health Care Without Harm. Health care’s climate footprint. 2019 [cited 2022 Mar 14]. Available online: https://www.arup.com/globalassets/downloads/insights/healthcares-carbon-footprint.pdf
  2. Malik A, Lenzen M, McAlister S, et al. The carbon footprint of Australian health care. Lancet Planet Health 2018;2:e27-35. [Crossref] [PubMed]
  3. Health. AGDo. Australia joins US and UK statement on decarbonising healthcare. 2024 [23 April 2024]. Available online: https://www.health.gov.au/ministers/the-hon-ged-kearney-mp/media/australia-joins-us-and-uk-statement-on-decarbonising-healthcare?utm_source
  4. Royal College of Physicians. Breaking the fever: Sustainability and climate change in the NHS. London: RCP London; 2018 Apr 30 [cited 2022 Mar 14]. Available online: https://www.rcplondon.ac.uk/improving-care/resources/breaking-the-fever-sustainability-and-climate-change-in-the-nhs/
  5. Costello A, Abbas M, Allen A, et al. Managing the health effects of climate change: Lancet and University College London Institute for Global Health Commission. Lancet 2009;373:1693-733. [Crossref] [PubMed]
  6. Watts N, Amann M, Arnell N, et al. The 2018 report of the Lancet Countdown on health and climate change: shaping the health of nations for centuries to come. Lancet 2018;392:2479-514. [Crossref] [PubMed]
  7. World Health Organization. Climate change and health. Geneva: World Health Organization; 2021 [cited 2022 Mar 01]. Available online: https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health
  8. England N. Carbon Emissions: Carbon Footprinting Study. Sustainable Development Commission. 2008. Available online: https://www.sd-commission.org.uk/data/files/publications/NHS_Carbon_Emissions_modelling%20report%20Update%20050809%20PB.pdf
  9. Eckelman MJ, Sherman J. Environmental Impacts of the U.S. Health Care System and Effects on Public Health. PLoS One 2016;11:e0157014. [Crossref] [PubMed]
  10. Cotton RT, Cohen AP. Eco-conservation and healthcare ethics: a call to action. Laryngoscope 2010;120:4-8. [Crossref] [PubMed]
  11. Conrardy J, Hillanbrand M, Myers S, et al. Reducing medical waste. AORN J 2010;91:711-21. [Crossref] [PubMed]
  12. Royal College of Physicians. Less waste, more health: a health professional’s guide to reducing waste. London: RCP; 2018 [cited 2022 Mar 3]. Available online: https://rcem.ac.uk/wp-content/uploads/2023/05/Less_waste_more_health_RCP.pdf
  13. New South Wales Government, Department of Environment, Climate Change and Water. Environmental benefits of recycling. Sydney: NSW Government; 2010 [cited 2022 Mar 06]. Available online: https://www.epa.nsw.gov.au/Your-environment/Recycling-and-reuse/business-government-recycling/recyculator/benefits-of-recycling
  14. Australian Government Department of Health. National Health and Climate Strategy 2024 [updated 3 December 2023]. Available online: https://www.health.gov.au/our-work/national-health-and-climate-strategy
  15. McAlister S, Barratt AL, Bell KJ, et al. The carbon footprint of pathology testing. Med J Aust 2020;212:377-82. [Crossref] [PubMed]
  16. McAlister S, Ou Y, Neff E, et al. The Environmental footprint of morphine: a life cycle assessment from opium poppy farming to the packaged drug. BMJ Open 2016;6:e013302. [Crossref] [PubMed]
  17. McGain F, Story D, Lim T, et al. Financial and environmental costs of reusable and single-use anaesthetic equipment. Br J Anaesth 2017;118:862-9. [Crossref] [PubMed]
  18. McGain F, Story D, Kayak E, et al. Workplace sustainability: the “cradle to grave” view of what we do. Anesth Analg 2012;114:1134-9. [Crossref] [PubMed]
  19. Gunda D, Bernard MP, Borschmann M. Implementing sustainable practices to reduce wastage and costs in adenotonsillectomy. ANZ J Surg 2025;95:708-12. [Crossref] [PubMed]
  20. Li JC, Forer M, Veivers D. Reference rate for post-tonsillectomy haemorrhage in Australia-A 2000-2020 national hospital morbidity database analysis. PLoS One 2022;17:e0273320. [Crossref] [PubMed]
  21. Australian Institute of Health and Welfare. Hospital Resources 2015–16: Australian hospital statistics. Health services series no. 78. Cat. no. HSE 190. Canberra: AIHW; 2017 [cited 2022 Mar 7]. Available online: https://www.aihw.gov.au/getmedia/d37a56cb-dc6b-4b28-a52f-8e00f606ce67/21035.pdf.aspx?inline=true
  22. Frischknecht R, Jungbluth N, Althaus HJ, et al. The ecoinvent database: overview and methodological framework. Int J Life Cycle Assess 2005;10:3-9.
  23. Wernet G, Bauer C, Steubing B, et al. The ecoinvent database version 3 (part I): overview and methodology. Int J Life Cycle Assess 2016;21:1218-30.
  24. Database & Support team at PRé Sustainability. SimaPro database manual. Methods library. 2022 [cited January 16, 2023]. Available online: https://simapro.com/wp-content/uploads/2022/07/DatabaseManualMethods.pdf
  25. Australian Institute of Health and Welfare. Procedure data cubes: web report. Canberra: AIHW. Available online: https://www.aihw.gov.au/reports/hospitals/procedures-data-cubes/contents/summary
  26. Cannon J, Tailor H, Douglas C. Carbon footprint of tonsillectomy. Surgeon 2024;22:242-7. [Crossref] [PubMed]
  27. Janik-Karpinska E, Brancaleoni R, Niemcewicz M, et al. Healthcare Waste-A Serious Problem for Global Health. Healthcare (Basel) 2023;11:242. [Crossref] [PubMed]
  28. Kagoma YK, Stall N, Rubinstein E, et al. People, planet and profits: the case for greening operating rooms. CMAJ 2012;184:1905-11. [Crossref] [PubMed]
  29. Morris DS, Wright T, Somner JE, et al. The carbon footprint of cataract surgery. Eye (Lond) 2013;27:495-501. [Crossref] [PubMed]
  30. Wyssusek KH, Keys MT, van Zundert AAJ. Operating room greening initiatives - the old, the new, and the way forward: A narrative review. Waste Manag Res 2019;37:3-19. [Crossref] [PubMed]
  31. Penn E, Yasso SF, Wei JL. Reducing disposable equipment waste for tonsillectomy and adenotonsillectomy cases. Otolaryngol Head Neck Surg 2012;147:615-8. [Crossref] [PubMed]
  32. Yeo JJY, Gupta KK, Mughal Z, et al. Rationalising surgical instruments in tonsillectomy: a pilot study to reduce greenhouse gas emissions and costs. J Laryngol Otol 2025;139:68-71. [Crossref] [PubMed]
  33. Overcash M. A comparison of reusable and disposable perioperative textiles: sustainability state-of-the-art 2012. Anesth Analg 2012;114:1055-66. [Crossref] [PubMed]
  34. Eckelman M, Mosher M, Gonzalez A, et al. Comparative life cycle assessment of disposable and reusable laryngeal mask airways. Anesth Analg 2012;114:1067-72. [Crossref] [PubMed]
  35. Singh N, Ogunseitan OA, Tang Y. Medical waste: Current challenges and future opportunities for sustainable management. Crit Rev Environ Sci Technol 2022;52:2000-22.
  36. Webster J, Radke E, George N, et al. Barrier properties and cost implications of a single versus a double wrap for storing sterile instrument packs. Am J Infect Control 2005;33:348-52. [Crossref] [PubMed]
  37. Thakrar J, Patel A, Joseph J. UK national survey on surgical gowning for tonsillectomy. J Laryngol Otol 2024;138:845-8. [Crossref] [PubMed]
  38. World Health Organization. Global guidelines for the prevention of surgical site infection. 2nd ed. Geneva: World Health Organization; 2018 [accessed 2025 Aug 24]. Available online: https://www.who.int/publications/i/item/9789241550475
  39. ENT & Audiology News. Sustainability guidelines to reduce single-use items in ENT outpatients. 2025. Available online: https://www.entandaudiologynews.com/features/ent-features/post/sustainability-guidelines-to-reduce-single-use-items-in-ent-outpatients
  40. ENT & Audiology News. Circular economy approach to reducing your carbon footprint in your ENT operating room. 2023. Available online: https://www.entandaudiologynews.com/features/ent-features/post/circular-economy-approach-to-reducing-your-carbon-footprint-in-your-ent-operating-room
  41. Farrell E, Smyth D. The environmental impact of personal protective equipment in a pre and post COVID era in the ENT clinic. Eur Arch Otorhinolaryngol 2021;278:5051-8. [Crossref] [PubMed]
  42. Masson-Delmotte V, Zhai P, Pirani A, et al. editors. International Plant Protection Convention. Cambridge University Press; 2021. Available online: https://www.cambridge.org/core/books/climate-change-2021-the-physical-science-basis/415F29233B8BD19FB55F65E3DC67272B
  43. Meiklejohn DA, Khan ZH, Nuñez KM, et al. Environmental Impact of Adult Tonsillectomy: Life Cycle Assessment and Cost Comparison of Techniques. Laryngoscope 2024;134:622-8. [Crossref] [PubMed]
  44. Spinos D, Doshi J, Garas G. Delivering a net zero National Health Service: where does otorhinolaryngology - head and neck surgery stand? J Laryngol Otol 2024;138:373-80. [Crossref] [PubMed]
  45. McGain F, McAlister S, McGavin A, et al. A life cycle assessment of reusable and single-use central venous catheter insertion kits. Anesth Analg 2012;114:1073-80. [Crossref] [PubMed]
doi: 10.21037/ajo-25-25
Cite this article as: Cavada MN, McAlister S, Sacks R, Birman CS. Theatre waste production and the carbon emissions from tonsillectomy surgery. Aust J Otolaryngol 2026;9:1.

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