Bibliometric Analysis of Scientific Publications on Environmental Sustainability in Operating Rooms

Year 2025, Volume: 9 Issue: 2, 108 - 116, 31.12.2025

Naciye Kaya , Meryem Yavuz Van Giersbergen

https://doi.org/10.52148/ehta.1776186

Abstract

This study aims to conduct a comprehensive bibliometric analysis of scientific publications on environmental sustainability in operating rooms, identifying key research trends, country-author collaborations, influential publications, and thematic structures in the field. A bibliometric analysis was conducted using the Web of Science Core Collection, which serves as both a database and an indexing platform. The dataset was obtained by searching English-language articles using the keywords “operating room,” “environmental sustainability,” and “green surgery”. A total of 162 eligible articles published between 1998 and 2025 were included. Data were analyzed using quantitative bibliometric techniques and visualized through VOSviewer software (version 1.6.19). The analysis included 162 publications, with a notable increase in research output over the last decade. The United States emerged as the most productive country, while Surgical Endoscopy and Other Interventional Techniques was identified as the most prolific journal. The most cited article was by Thiel et al. (2017), focused on cataract surgery and life cycle assessment, with 173 citations. Co-citation and co-authorship analyses revealed that authors such as McGain, Sherman, and Eckelman played central roles in the field. Two main thematic clusters were identified: (1) environmental impacts of surgical processes, (2) carbon footprint and life cycle assessments. The average number of citations per publication was 13.84. The findings highlight an increasing academic interest in sustainable operating room practices, with growing focus on reducing the carbon footprint, optimizing waste management, and implementing life cycle assessment methodologies. Future studies should aim to adopt a more holistic sustainability perspective, incorporating ethical, economic, and political dimensions. Interdisciplinary collaborations and policy-level engagements will be crucial for advancing green practices in surgical environments.

Keywords

Bibliometric , carbon footprint , environmental sustainability , green surgery , operating room

References

• 1. Almukhtar, A., Batcup, C., Bowman, M., Winter-Beatty, J., Leff, D., Demirel, P., Porat, T., & Judah, G. (2024). Barriers and facilitators to sustainable operating theatres: a systematic review using the Theoretical Domains Framework. International journal of surgery (London, England), 110(1), 554–568. https://doi.org/10.1097/JS9.0000000000000829
• 2. Beloeil, H., & Albaladejo, P. (2021). Initiatives to broaden safety concerns in anaesthetic practice: The green operating room. Best Practice & Research Clinical Anaesthesiology, 35(1), 83–91. https://doi.org/10.1016/j.bpa.2020.07.010
• 3. Dolcini, M., Ferrè, F., Brambilla, A., & Capolongo, S. (2025). Integrating environmental sustainability into hospitals performance management systems: a scoping review. BMC health services research, 25(1), 764. https://doi.org/10.1186/s12913-025-12928-x
• 4. Donthu, N., Kumar, S., Mukherjee, D., Pandey, N., & Lim, W. M. (2021). How to conduct a bibliometric analysis: An overview and guidelines. Journal of Business Research, 133, 285–296. https://doi.org/10.1016/j.jbusres.2021.04.070
• 5. Johnson, S. M., Marconi, S., Sanchez-Casalongue, M., Francis, N., Huo, B., Alseidi, A., Alimi, Y. R., Pietrabissa, A., Arezzo, A., Frountzas, M., Bellato, V., Potapov, O., Barach, P., Rems, M., Bello, R. J., Nijhawan, S., Oslock, W. M., Sathe, T. S., Hall, R. P., Miller, B., … Sylla, P. (2024). Sustainability in surgical practice: a collaborative call toward environmental sustainability in operating rooms. Surgical endoscopy, 38(8), 4127–4137. https://doi.org/10.1007/s00464-024-10962-0
• 6. Kara, Ö., & Ak, E. S. (2025). Carbon footprint and sustainability in the operating room: What to know on the road to becoming a green operating room. Lokman Hekim Journal of the History of Medicine and Folk Medicine, 15(2), 389–399. https://doi.org/10.31020/mutftd.1549201
• 7. Karliner, J., Slotterback, S., Boyd, R., Ashby, B., & Steele, K. (2019). Health care’s climate footprint: How the health sector contributes to the global climate crisis and opportunities for action. Health Care Without Harm. https://noharm-global.org/documents/health-care-climate-footprint-report
• 8. MacNeill, A. J., Lillywhite, R., & Brown, C. J. (2017). The impact of surgery on global climate: A carbon footprinting study of operating theatres in three health systems. The Lancet Planetary Health, 1(9), e381–e388. https://doi.org/10.1016/S2542-5196(17)30162-6
• 9. NHS England. (2022, July). Delivering a “net zero” National Health Service – July 2022 update (Green Plan update B1728). https://www.england.nhs.uk/greenernhs/wp-content/uploads/sites/51/2022/07/B1728-delivering-a-net-zero-nhs-july-2022.pdf Access Date July 19, 2025.
• 10. NSW Health. (2024). Desflurane and environmental impact. Government of New South Wales. https://www.health.nsw.gov.au/netzero/Pages/environmental-impact-desflurane.aspx
• 11. Perrego, K. (2017). Improving staff knowledge of perioperative regulated-waste management. AORN Journal, 105(1), 85–91. https://doi.org/10.1016/j.aorn.2016.11.005
• 12. Pinheiro, O. L. R., Scavarda, A., & Machado, F. V. (2024). Sustainability in operating rooms: Awareness among health professionals. Seven Academic Publications.
• 13. Plezia, D., Sabol, V. K., Nelson, C., & Simmons, V. C. (2024). Improving waste segregation in the operating room to decrease overhead cost. Quality Management in Health Care, 33(1), 44–51. https://doi.org/10.1097/QMH.0000000000000416
• 14. Romanello, M., Walawender, M., Hsu, S.-C., Moskeland, A., Palmeiro-Silva, Y., Scamman, D., Ali, Z., Ameli, N., Angelova, D., Ayeb-Karlsson, S., Basart, S., Beagley, J., Beggs, P. J., Blanco-Villafuerte, L., Cai, W., Callaghan, M., Campbell-Lendrum, D., Chambers, J. D., … Costello, A. (2024). The 2024 report of the Lancet Countdown on health and climate change: Facing record-breaking threats from delayed action. The Lancet, 404(10465), 1847–1896.
• 15. Vozzola, E., Overcash, M., & Griffing, E. (2020). An environmental analysis of reusable and disposable surgical gowns. AORN Journal, 111(3), 315–325. https://doi.org/10.1002/aorn.12885
• 16. Watts, N., Amann, M., Arnell, N., Ayeb-Karlsson, S., Belesova, K., Boykoff, M., … Costello, A. (2023). The 2023 report of the Lancet Countdown on health and climate change: The imperative for a health-centred response in a world facing irreversible harms. The Lancet, 402(10417), 1976–2023. https://doi.org/10.1016/S0140-6736(23)01859-7
• 17. World Health Organization. (2023, October 12). Climate change: Key facts. https://www.who.int/news-room/fact-sheets/detail/climate-change-and-health
• 18. Zurynski, Y., Herkes-Deane, J., Holt, J., McPherson, E., Lamprell, G., Dammery, G., Meulenbroeks, I., Halim, N., & Braithwaite, J. (2022). How can the healthcare system deliver sustainable performance? A scoping review. BMJ Open, 12(5), e059207. https://doi.org/10.1136/bmjopen-2021-059207.