{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T16:42:56Z","timestamp":1788108176293,"version":"build-2803163510"},"reference-count":31,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2024,1,1]],"date-time":"2024-01-01T00:00:00Z","timestamp":1704067200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Foot &amp; Ankle Orthopaedics"],"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Climate change poses a substantial threat to human health, and operating rooms (ORs) have an outsized environmental impact. The Program for Research in Sustainable Medicine (PRiSM) designed a protocol for minor foot and ankle surgery intended to reduce waste, streamline instrument trays, and minimize laundry. We conducted a randomized controlled trial to compare the carbon footprint of procedures performed using the PRiSM protocol vs a traditional protocol.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Forty adult patients undergoing foreign body removal, hammertoe correction, toe amputation, hardware removal, mass excision, or gastrocnemius recession were randomized to the PRiSM or our \u201cTraditional\u201d protocol. The PRiSM protocol used a smaller instrument tray, fewer drapes and towels, and minimal positioning blankets. No changes were made to surgical site preparation or operative techniques. Environmental impact was estimated using the carbon footprint, measured in kilograms of carbon dioxide equivalents (CO\n                      <jats:sub>2<\/jats:sub>\n                      e). Emissions associated with OR waste, instrument processing, and laundry were calculated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      On average, PRiSM cases had a smaller carbon footprint than Traditional cases (17.3\u2009kg CO2e [SD\u2009=\u20093.2] vs 20.6\u2009kg CO\n                      <jats:sub>2<\/jats:sub>\n                      e [SD\u2009=\u20092.0], P\u2009&lt;\u2009.001). Waste-associated emissions from PRiSM cases were reduced (16.0\u2009kg CO\n                      <jats:sub>2<\/jats:sub>\n                      e [SD\u2009=\u20092.7] vs 18.4\u2009kg CO\n                      <jats:sub>2<\/jats:sub>\n                      e [SD\u2009=\u20091.8], P\u2009=\u2009.002), as were modeled instrument processing\u2013related emissions (0.34 vs 0.91\u2009kg CO\n                      <jats:sub>2<\/jats:sub>\n                      e). One superficial surgical site infection occurred in each group.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>We found a small but statistically significant reduction in the environmental impact of minor foot and ankle surgery when using the PRiSM vs Traditional protocol. The environmental impact of these cases was dominated by plastic waste\u2013related emissions. Orthopaedic surgeons should think critically about what components of their surgical setup are truly necessary for patient care, as minor changes in product utilization can have significant impacts on waste and greenhouse gas emissions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>Level I, randomized controlled trial.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/24730114241238231","type":"journal-article","created":{"date-parts":[[2024,3,19]],"date-time":"2024-03-19T05:30:20Z","timestamp":1710826220000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":10,"title":["Carbon Footprint of Minor Foot and Ankle Surgery: A Randomized Controlled Trial"],"prefix":"10.1177","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9274-1073","authenticated-orcid":false,"given":"Emily B.","family":"Parker","sequence":"first","affiliation":[{"name":"Harvard Medical School, Department of Orthopedic Surgery, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3848-1677","authenticated-orcid":false,"given":"Eric M.","family":"Bluman","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Department of Orthopedic Surgery, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Chiodo","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Department of Orthopedic Surgery, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Martin","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Department of Orthopedic Surgery, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1555-9494","authenticated-orcid":false,"given":"Jeremy T.","family":"Smith","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Department of Orthopedic Surgery, Brigham and Women\u2019s Hospital, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,3,19]]},"reference":[{"key":"bibr1-24730114241238231","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-023-03107-9"},{"key":"bibr2-24730114241238231","doi-asserted-by":"publisher","DOI":"10.1016\/j.arth.2018.09.061"},{"key":"bibr3-24730114241238231","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.OA.22.00129"},{"key":"bibr4-24730114241238231","doi-asserted-by":"publisher","DOI":"10.1111\/iwj.14350"},{"key":"bibr5-24730114241238231","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60935-1"},{"key":"bibr6-24730114241238231","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2005.04.005"},{"key":"bibr7-24730114241238231","doi-asserted-by":"publisher","DOI":"10.1016\/j.oto.2022.100995"},{"key":"bibr8-24730114241238231","doi-asserted-by":"publisher","DOI":"10.3758\/BF03193146"},{"key":"bibr9-24730114241238231","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2018.07.021"},{"key":"bibr10-24730114241238231","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS-D-21-00009"},{"key":"bibr11-24730114241238231","doi-asserted-by":"publisher","DOI":"10.1177\/17531934231176952"},{"key":"bibr12-24730114241238231","doi-asserted-by":"publisher","DOI":"10.1001\/archsurg.2010.343"},{"key":"bibr13-24730114241238231","doi-asserted-by":"publisher","DOI":"10.1016\/j.resconrec.2020.104704"},{"key":"bibr14-24730114241238231","doi-asserted-by":"publisher","DOI":"10.1007\/s00170-020-06367-7"},{"key":"bibr15-24730114241238231","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(17)30162-6"},{"key":"bibr16-24730114241238231","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2020.10.013"},{"key":"bibr17-24730114241238231","unstructured":"Medline. 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