Environmental emissions reduction of a preoperative evaluation center utilizing telehealth screening and standardized preoperative testing guidelines

Erin Y. Wang, Jill E. Zafar, Charlotte M. Lawrence, Lyndsay F. Gavin, Somya Mishra, Adjoa Boateng, Cassandra L. Thiel, Robert Dubrow, Jodi D. Sherman

Research output: Contribution to journalArticlepeer-review


The healthcare sector is responsible for 8.5% of greenhouse gas (GHG) emissions in the United States. To prevent catastrophic effects of climate change, urgent reductions in GHG emissions are needed. Unnecessary preoperative testing and clinic visits contribute to excessive utilization of healthcare resources and patient travel, and addressing them may help reduce emissions. A retrospective cross-sectional analysis of GHG emissions associated with pre- and post- implementation of a novel telehealth preoperative evaluation process was performed on 298 American Society of Anesthesiologists Class I-III patients undergoing elective spine surgery at Yale New Haven Hospital. Electronic health records were evaluated to determine patient health status and necessary or unnecessary preoperative tests and clinic visits. Life cycle assessment and U.S. EPA GHG calculator were used to estimate carbon dioxide equivalent (CO2e) emissions from preoperative testing, clinic visits, and patient commuting. GHG emissions were reduced by 8.09 kg CO2e (9.6%) per patient, from 84.52 kg CO2e pre-intervention to 76.43 kg CO2e post-intervention (p = 0.019). The largest reduction, 14.71 kg CO2e, stemmed from fewer in-person clinic evaluations. An additional reduction of 18.07 kg CO2e per patient would have been possible if clinic performance were optimized (only necessary testing performed), resulting in a total reduction of 26.16 kg CO2e (31%). A preoperative clinic using established testing guidelines and telehealth can reduce environmental emissions. With more than 40 million annual surgeries nationwide, concerted effort to reduce unnecessary testing and visits should help curtail healthcare GHG emissions.

Original languageEnglish (US)
Article number105652
JournalResources, Conservation and Recycling
StatePublished - Aug 2021


  • Anesthesiology
  • Carbon emissions
  • Healthcare
  • Low-value care
  • Preoperative evaluation
  • Telehealth

ASJC Scopus subject areas

  • Waste Management and Disposal
  • Economics and Econometrics


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