J Hand Surg Am. 2026 Jun 1:S0363-5023(26)00320-5. doi: 10.1016/j.jhsa.2026.04.015. Online ahead of print.
ABSTRACT
PURPOSE: Wide-awake local anesthesia no tourniquet (WALANT) hand surgery produces less waste and carbon emissions than traditional operating room surgery. High procedural volumes and expanding adoption among hand surgeons' position WALANT as a continued optimal target for waste-reduction initiatives. This study quantifies waste reduction after recycling implementation in a WALANT procedure room and identifies materials most contributory to total waste production.
METHODS: A prospective recycling intervention study was conducted at a single institution. Baseline waste generation was measured for 33 WALANT hand procedures over 5 days in a clinic procedure room prior to the recycling intervention. A recycling intervention was then initiated, wherein clean recyclable materials were separated from total waste and recycled. All waste was segregated into nonrecyclable versus recyclable streams and weighed over 4 days. Waste per case before and after intervention was calculated. Additionally, weight and recycling status (recyclable/nonrecyclable) were recorded for every item included in a WALANT carpal tunnel release kit at our facility.
RESULTS: Preintervention WALANT procedures generated 3.30 lbs (1.50 kg) of waste per case on average. After recycling implementation, 9.3 lbs (4.22 kg) was diverted to recycling, corresponding to 0.49 lbs (0.22 kg) per case and 16% of the postintervention total waste stream. Nonrecycled waste decreased from 3.30 lbs (1.50 kg) per case before intervention to 2.50 lbs (1.13 kg) per case after intervention, a reduction of 0.80 lbs (0.36 lbs) per case. Major contributors to remaining nonrecyclable waste included surgical drapes and sterile solution bottles, constituting ∼43% and ∼27% of nonrecyclable waste by weight, respectively.
CONCLUSIONS: Recycling implementation in the WALANT procedure room diverted approximately 16% of the total waste to recycling. The intervention required minimal workflow modification and demonstrated measurable reductions in procedural waste, with effects that increase proportionally in high-volume clinical settings. These findings highlight the importance of ongoing innovation in surgical material management.
TYPE OF STUDY/LEVEL OF EVIDENCE: Economic/decision analysis IV.
PMID:42227929 | DOI:10.1016/j.jhsa.2026.04.015