PURPOSE: Environmental sustainability has become a critical initiative among several industries, but it is rarely mentioned in healthcare. The environmental footprint of surgical procedures is not only based on the resource utilization of operating rooms, but rather on the entire value chain of intraoperative products utilized. The purpose of this investigation was to assess the corporate environmental responsibility of two leading manufacturers of internal fixation hardware. METHODS: The sustainability practices of two leading internal fixation hardware manufacturers were investigated based on self-reported corporate environmental data. Data were standardized per $1 million USD in revenue. Recent corporate initiatives and their resulting sustainability impact were analyzed over the last six years, specifically within the categories of greenhouse emissions (in metric tons of carbon dioxide equivalent, MTCO2e), water withdrawal (in cubic meters, m3), solid waste (in metric tons), and energy utilization (in gigajoules, GJ). RESULTS: Regarding greenhouse emissions, Company S most recently reported 10.0 MTCO2e per $1M in revenue, while their competitor Company D reported 12.0 MTCO2e per $1M in revenue. Company S recently reduced its carbon footprint at a rate of 1.9 MTCO2e per $1M per year, which has been nearly twice as fast as Company D at 1.0 MTCO2e per $1M per year. Regarding water withdrawal, Company S utilized 5.6 m3 per $1M in revenue, whereas Company D utilized only 1.43 m3 per $1M in revenue. Neither company has made substantial changes to their water withdrawal rates. Regarding solid waste, Company S only produced 0.34 tons of solid waste per $1M in revenue, whereas Company D produced 1.22 tons of solid waste per $1M in revenue. Company D currently recycles an impressive 86.9% of its nonhazardous solid waste. Over the past five years, Company S has diverted 25 million pounds of waste from landfills by reprocessing end of lifecycle products. Regarding energy utilization, Company S utilized 123.2 GJ per $1M in revenue, whereas Company D utilized 155 GJ per $1M in revenue. Both companies have made large strides in their energy reductions, such that Company S has reduced their energy utilization by 2.5 GJ per $1M per year, and Company D has reduced their energy utilization by 7.0 GJ per $1M per year. Company S more than doubled its renewable electric power utilization from 102.7 GJ per year to 241.7 GJ per year. While this is impressive, it still only represents 13.6% of its total purchased energy utilization. CONCLUSION: There are substantial differences in the business practices between internal fixation hardware suppliers. Physician leaders need to begin discussing responsible resource procurement. Future research over the coming months will investigate various other suppliers to analyze the supply chain footprint of each of our procedures, as well as the supply chain footprint of our plastic surgery department overall.
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