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Rethinking The Surgical Field: The Impact Of OR Draping Practices On Waste And Carbon Emissions
Summary
Surgeons found that using fewer disposable gowns and drapes for minor skin surgeries cut medical waste by over 3 kg per procedure, cut costs by thousands of dollars, and didn't increase infection risk. This matters because those disposable materials are made from non-biodegradable plastic that's carbon-intensive to produce, so simple changes to surgical routines could meaningfully shrink hospitals' environmental footprint without compromising patient safety.
PURPOSE: Operating rooms are significant contributors to environmental waste, pollution, and healthcare expenses. Despite compelling arguments questioning the necessity of full gowning and draping during small skin and superficial procedures, many surgeons continue to adhere to traditional practices, generating excess waste. Disposable gowns and drapes made from Spunbond-Meltblown-Spunbond (SMS) polypropylene plastic are particularly problematic due to their carbon-intensive production and non-biodegradability. Our study aims to assess the effectiveness of minimal draping techniques and minimal surgical packs in reducing OR waste. METHODS: After receiving Institutional Review Board approval, a prospective observational analysis was conducted on patients who underwent superficial excisional repairs by four plastic and reconstructive surgeons from July 2023 to August 2025 at a childrens hospital. Participating surgeons were stratified into two groups based on their use of either standard or minimal draping and minimal packs techniques. Waste was sorted and weighed post-operatively using standardized protocols. Clinical outcomes were recorded on chart review. Independent t-tests were performed to compare waste outputs between the cohorts. Life-cycle analysis was conducted to evaluate the environmental impact of SMS polypropylene plastic drapes and gowns from resource extraction to disposal. A cost analysis was also performed using robust regression to account for variability and outliers in cost data, providing reliable estimates of savings associated with reduced gown and drape utilization. RESULTS: Data was collected from 40 cases, with 20 cases using minimal draping. Cases performed with a minimal draping protocol generated significantly less waste compared to standard draping methods, with a mean reduction of 3.1 kg per case (p<0.05). Waste reduction was predominantly driven by eliminating disposable gowns and decreasing drape-related material use, saving 158g of gowns per person scrubbed and 0.47 kg of drapes per case (p<0.05). Based on the life cycle analysis of SMS fabric, this reduction translates to an estimated 2.9-5.3 kg CO2e (carbon dioxide equivalents) saved per case. Furthermore, minimal draping significantly reduced costs, saving about $7,000 per case. There were no surgical site infections within 30 days for both groups. CONCLUSION: Minimal draping protocols and minimal surgical packs may be an effective and safe way to reduce surgical waste. Implementing environmentally conscious strategies in the operating room can also significantly reduce associated costs. These findings highlight the critical need to reassess surgical protocols to better align with sustainable healthcare practices. To achieve meaningful and lasting change, it's imperative to provide comprehensive education to clinical staff and to initiate large-scale institutional reforms.© 2026. Plastic Surgery Research Council | All rights reserved |*Source: https://ps-rc.org/meeting/Program/2026/94.cgi*