Surgical departments across the globe are recognised as significant sources of greenhouse gas (GHG) emissions, accounting for 20–33.3 % of a hospital's carbon footprint [1,2]. In 2009, The Lancet called climate change the “biggest global health threat of the 21st century” [3], and with this in mind, surgical departments have become major targets in reducing carbon emissions. Substantial GHG emissions come from the need for sterility in the operating theatre (OT), which is achieved through complex heating, ventilation, air conditioning, sterilisation of instruments, specific surgical apparel and single-use items. All of the aforementioned factors can be targeted to improve a surgical department's environmental impact. The Health Service Executive in Ireland has published a Climate Action Strategy 2023–2050, where OTs and single-use items are specific areas of improvement in achieving net zero emissions [4].

The most commonly performed operations at our elective orthopaedic centre are total knee arthroplasty (TKA) and total hip arthroplasty (THA), for which the demand was projected to increase by 673 % and 174 %, respectively, from 2005 to 2030 [5]. Safely minimising waste production to increase the overall efficiency of a centre is vital to its sustainability. A scoping review in 2022 found that THA and TKA produced the most amount of waste in orthopaedics, at 12.6 kg and 13.1 kg produced per case, respectively [2]. The recent rise in literature related to the environment has investigated various sub-specialities in orthopaedics with varying methods and outcomes employed by authors, making it difficult to synthesise collectively. Studies demonstrating waste breakdown in OTs and related GHG emissions have been useful in finding targets for improvement, with some having found energy use as the main culprit while others found disposable items [6].

The focus of this research was on single-use items used across all adult upper limb and lower limb theatres, with a focus on those with reusable alternatives such as surgical gowns, drapes and diathermy pads. Single-use items in the orthopaedic OTs have been referred to in waste segregation studies and indeed recognised as significant contributors [6,7], however not been investigated separately to our knowledge. We aimed to demonstrate the volume of waste produced from single-use items that are disposed of in the hazardous waste bin, and also the blood loss associated with each operation in arthroplasty, foot and ankle and upper limb OTs, hypothesising that the majority of operations have low blood loss rates, correlating with minimal to no contamination of surgical gowns. We also aimed to demonstrate the carbon emissions associated with single-use items.