Perioperative Care
Summary / Key takeaways
Perioperative care plays a vital role in healthcare delivery, yet it is also a notable source of environmental impact. Unnecessary interventions, high-emission anesthetic gases, reliance on single-use devices, and poor waste management all increase the carbon footprint of surgical care. Reducing avoidable interventions and lowering the environmental impact of necessary care can improve both system efficiency and patient outcomes while supporting climate resilience.
Opportunities for more sustainable perioperative care generally fall into four key areas. Minimizing unnecessary care, such as low-value tests or procedures, can reduce emissions and costs without compromising outcomes. Addressing direct emissions, particularly through more sustainable anesthesia practices, offers significant potential for carbon reduction. Transitioning from single-use items to safe, reusable alternatives can decrease waste generation and resource use. Finally, improving waste segregation and management ensures that materials are processed appropriately minimizes resource-intensive processing and avoids unnecessary environmental burden.
Advancing sustainability in perioperative settings requires thoughtful implementation. Education and awareness help drive behavior change, while supportive infrastructure and procurement practices make sustainable choices more accessible. Integrating these efforts into clinical workflows and aligning them with evidence-based standards can enable meaningful, lasting improvements.
Playbook: Sustainable Perioperative Care
Suggested Citation:
Simms N, Devitt K, Irani C, Khan N, Meng F. Sustainable Perioperative Care. Version 1.1. [Internet]. CASCADES; 2023 [cited DATE]. Available from: https://
Playbook: Regional Anesthesia in Breast Surgery
Suggested Citation:
MacNeill, A, McAtee, A. Sustainable Anesthesia for Breast Surgery. Version 1.1. [Internet]. CASCADES; 2023 [cited DATE]. Available from: https://cascadescanada.ca/.
Dashboard: Sustainable Perioperative Care Dashboard
Scorecard: Sustainable Perioperative Care Scorecard
Supporting Resources

Device Remanufacturing with Laura Donahoe
Laura Donahoe presents on device remanufacturing in perioperative care during an ONSQIN event.
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Pharmaceutical Waste with Dr. Ali Abbass
Dr. Ali Abbass’ presentation on Greening the Operating Room during the Nov 25, 2022 Fundamentals of Sustainable Operating Rooms course offered in partnership between CASCADES and ONSQIN.
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Clinical and Non-Clinical Waste Segregation with Ali Abbass
Dr. Ali Abbass’ presentation on Greening the Operating Room during the Nov 25, 2022 Fundamentals of Sustainable Operating Rooms course offered in partnership between CASCADES and ONSQIN.
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Follow the Waste with Ali Abbass
Dr. Ali Abbass’ presentation on Greening the Operating Room during the Nov 25, 2022 Fundamentals of Sustainable Operating Rooms course offered in partnership between CASCADES and ONSQIN.
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PVC 123 Recycling Program with Dr. Ali Abbass
Dr. Ali Abbass, Anesthesiologist, St. Joseph’s Health Centre, Unity Health Toronto discusses PVC 123 recycling program in perioperative care.
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OR Recycling at UHN with Ed Rubenstein
Ed Rubinstein, Director of Environmental Compliance, Energy, and Sustainability, University Health Network discusses OR recycling
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