Quantification and recycling of orthopedic surgical waste: Toward circular economy approaches in hospitals

Resource-intensive procedures contribute to generating a significant quantity of waste in hospitals. To respond to growing environmental concerns, recycling initiatives have gained traction, especially in tertiary care hospitals. However, the recycling potential of perioperative settings is still overlooked. Total hip and knee arthroplasty surgeries account for large waste production by the increasing use of patient-specific and modular implants. This study aimed to assess the impact of newly implemented eco-friendly policies on waste generation and recycling efforts across orthopedic subspecialties in Pisa Hospital. A total of 666.6 kg of waste was collected (86 cases, average 7.75 kg per case). Results confirmed that arthroplasty generated the highest quantity of surgical waste (9.34 kg per case), with biological waste accounting for the largest fraction (67.8%), compared with recyclable (21.8%) and non-recyclable (10.4%) wastes. Arthroplasty surgeries produced more recyclable waste per case in the pre-operative and intra-operative periods than the other subspecialties. Pre-operative waste demonstrated a higher percentage of recyclable materials (58.1 %) compared to intra-operative waste (12.8 %). Averagely, 21.8 % of waste per case could be recycled. We demonstrated the possibility of recycling multilayer medical packaging by solvent-extraction. Recovered polyethylene terephthalate was characterized and further electrospun into cytocompatible fiber meshes with ultrafine size and uniform morphology, proposed for application as filtering devices and face masks and analyzed via Life Cycle Assessment. Finally, other recycling opportunities for second-life plastics in orthopedic settings were discussed. Our findings underscore the potential for reducing the environmental footprint of orthopedic surgery by promoting sustainable practices, effective waste management and recycling protocols.