{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T06:53:03Z","timestamp":1779173583418,"version":"3.51.4"},"reference-count":40,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T00:00:00Z","timestamp":1719360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Center For Advancing Translational Science of the National Institute of Health (NIH)","award":["UL1 TR002384"],"award-info":[{"award-number":["UL1 TR002384"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: While the economic cost of adult spinal deformity (ASD) surgery has been studied extensively, its environmental impact is unknown. The aim of this study is to determine the carbon footprint (CF) associated with ASD surgery. Methods: ASD patients who underwent &gt; four levels of corrective surgery between 2017 and 2021 were included. The open group included a posterior-only, single-stage technique, while the minimally invasive surgery (MIS) group was defined as the use of lateral interbody fusion and percutaneous posterior screw fixation. The two groups were propensity-score matched to adjust for baseline demographic, surgical, and radiographic characteristics. Data on all disposables and reusable instruments, anesthetic gas, and non-gas medications used during surgery were collected from medical records. The CF of transporting, using, and disposing of each product and the footprint of energy use in operating rooms were calculated. The CF produced was evaluated using the carbon dioxide equivalent (CO2e), which is relative to the amount of CO2 with an equivalent global warming potential. Results: Of the 175 eligible patients, 15 pairs (65 \u00b1 9 years, 47% female) were properly matched and analyzed for all variables. The average CF generated per case was 147.7 \u00b1 37.3 kg-CO2e, of which 54% was attributable to energy used to sterilize reusable instruments, followed by anesthetic gas released into the environment (17%) and operating room air conditioning (15%). Conclusions: The CF generated during ASD surgery should be reduced using a multidisciplinary approach, taking into account that different surgical procedures have different impacts on carbon emission sources.<\/jats:p>","DOI":"10.3390\/jcm13133731","type":"journal-article","created":{"date-parts":[[2024,6,26]],"date-time":"2024-06-26T09:29:33Z","timestamp":1719394173000},"page":"3731","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["What Is the Carbon Footprint of Adult Spinal Deformity Surgery?"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4908-309X","authenticated-orcid":false,"given":"Hiroyuki","family":"Nakarai","sequence":"first","affiliation":[{"name":"Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA"},{"name":"Department of Orthopaedic Surgery, The University of Tokyo, Bunkyo-ku, Tokyo 113-8655, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cole","family":"Kwas","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Mai","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nishtha","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bo","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John C.","family":"Clohisy","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert K.","family":"Merrill","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Pajak","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jerry","family":"Du","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2726-2417","authenticated-orcid":false,"given":"Gregory S.","family":"Kazarian","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Austin C.","family":"Kaidi","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6170-5220","authenticated-orcid":false,"given":"Justin T.","family":"Samuel","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sheeraz","family":"Qureshi","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3723-062X","authenticated-orcid":false,"given":"Matthew E.","family":"Cunningham","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francis C.","family":"Lovecchio","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Han Jo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Hospital for Special Surgery, New York, NY 10021, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1861","DOI":"10.1016\/S0140-6736(15)60854-6","article-title":"Health and Climate Change: Policy Responses to Protect Public Health","volume":"386","author":"Watts","year":"2015","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1146\/annurev-publhealth-012420-105026","article-title":"Extreme Weather and Climate Change: Population Health and Health System Implications","volume":"42","author":"Ebi","year":"2021","journal-title":"Annu. 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