Carbon Footprint of Outpatient Cataract Surgery in Germany: Multicentre Analysis of Emission Sources, Variability, and Opportunities for Transparent Reporting
10 affiliations
- 1Department of Ophthalmology, University of Leipzig Medical Centre, Leipzig, Germany
- 2Eye Centre, Medical Faculty, University of Freiburg, Freiburg, Germany
- 3Department of Ophthalmology, University Eye Hospital Tübingen, Tübingen, Germany
- 4Eye Hospital, Ruhr University Bochum, Bochum, Germany
- 5Department of Ophthalmology, University Hospital Düsseldorf, Düsseldorf, Germany
- 6Department of Ophthalmology, University Medical Centre Mainz, Mainz, Germany
- 7Department of Ophthalmology, University Medical Centre Göttingen, Göttingen, Germany
- 8Department of Ophthalmology, Saarland University Medical Centre, Homburg, Germany
- 9Department of Ophthalmology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
- 10Eye Department, Centre for Refractive Surgery Münster, Münster, Germany
Abstract
Introduction: Outpatient cataract surgery is one of the most frequently performed surgical procedures worldwide. Reducing its carbon footprint without compromising hygiene and patient safety offers substantial potential for mitigating healthcare-related greenhouse gas emissions. This multicentre study quantified the carbon footprint of outpatient cataract surgery across ten heterogeneous German tertiary centres and examined intercentre variability in emissions as well as the extent to which current data support transparent, standardised reporting.
Methods: Between December 2022 and March 2023, standardised on-site assessments collected data on staff and patient travel, electricity consumption, disposable material use, and waste generation. Data were converted into carbon dioxide equivalents (CO2e) using emission factors from national environmental agencies. Since detailed life cycle and sterilisation data could not be obtained for instrument manufacture and reprocessing, these components were modelled for all centres.
Results: The centres showed substantial inter-site variation in all major emission categories. Disposable materials (2.53–8.30 kg CO2e) and sterilisation (2.62–7.13 kg CO2e) were the dominant contributors, together accounting for 56.6–84.6% of total emissions. Electricity use contributed 1.0%–18.5%, whereas waste disposal remained low (≤0.4%). Based on the combination of measured and modelled components, the estimated carbon footprint averaged 14.09 kg CO2e per cataract procedure (95% CI: 12.08–16.11 kg), with centre-level values ranging from 10.07 to 18.70 kg.
Conclusion: Substantial emission reductions can be achieved by streamlining material use and improving sterilisation workflow. Transparent reporting that defines system boundaries, specifies uncertainties, and provides access to data collection methods is essential for comparability and for establishing reliable benchmarks in sustainable surgical practice. This study provides a comprehensive multicentre carbon footprint analysis for outpatient cataract surgery in Germany and offers a transparent framework that guides targeted reduction strategies.
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BibTeX
@article{wehrle2026carbon,
title = {{Carbon Footprint of Outpatient Cataract Surgery in Germany: Multicentre Analysis of Emission Sources, Variability, and Opportunities for Transparent Reporting}},
author = {Franka Wehrle and Hansjürgen Agostini and Karl Ulrich Bartz-Schmidt and H. Burkhard Dick and Gerd Geerling and Adrian Gericke and Hans Hoerauf and Christoph Holtmann and Paul Kohlhas and Thabo Lapp and Norbert Pfeiffer and Berthold Seitz and Martin S. Spitzer and Maria Steuernagel and Marcus W. Storch and Suphi Taneri and Focke Ziemssen and Christian Girbardt},
journal = {Ophthalmologica. International Journal of Ophthalmology},
year = {2026},
month = aug,
doi = {10.1159/oph/aeeag011},
url = {https://doi.org/10.1159/oph/aeeag011},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Carbon Footprint of Outpatient Cataract Surgery in Germany: Multicentre Analysis of Emission Sources, Variability, and Opportunities for Transparent Reporting
AU - Franka Wehrle
AU - Hansjürgen Agostini
AU - Karl Ulrich Bartz-Schmidt
AU - H. Burkhard Dick
AU - Gerd Geerling
AU - Adrian Gericke
AU - Hans Hoerauf
AU - Christoph Holtmann
AU - Paul Kohlhas
AU - Thabo Lapp
AU - Norbert Pfeiffer
AU - Berthold Seitz
AU - Martin S. Spitzer
AU - Maria Steuernagel
AU - Marcus W. Storch
AU - Suphi Taneri
AU - Focke Ziemssen
AU - Christian Girbardt
PY - 2026
DA - 2026/08/31
JO - Ophthalmologica. International Journal of Ophthalmology
DO - 10.1159/oph/aeeag011
UR - https://doi.org/10.1159/oph/aeeag011
AB - Introduction: Outpatient cataract surgery is one of the most frequently performed surgical procedures worldwide. Reducing its carbon footprint without compromising hygiene and patient safety offers substantial potential for mitigating healthcare-related greenhouse gas emissions. This multicentre study quantified the carbon footprint of outpatient cataract surgery across ten heterogeneous German tertiary centres and examined intercentre variability in emissions as well as the extent to which current data support transparent, standardised reporting. Methods: Between December 2022 and March 2023, standardised on-site assessments collected data on staff and patient travel, electricity consumption, disposable material use, and waste generation. Data were converted into carbon dioxide equivalents (CO2e) using emission factors from national environmental agencies. Since detailed life cycle and sterilisation data could not be obtained for instrument manufacture and reprocessing, these components were modelled for all centres. Results: The centres showed substantial inter-site variation in all major emission categories. Disposable materials (2.53–8.30 kg CO2e) and sterilisation (2.62–7.13 kg CO2e) were the dominant contributors, together accounting for 56.6–84.6% of total emissions. Electricity use contributed 1.0%–18.5%, whereas waste disposal remained low (≤0.4%). Based on the combination of measured and modelled components, the estimated carbon footprint averaged 14.09 kg CO2e per cataract procedure (95% CI: 12.08–16.11 kg), with centre-level values ranging from 10.07 to 18.70 kg. Conclusion: Substantial emission reductions can be achieved by streamlining material use and improving sterilisation workflow. Transparent reporting that defines system boundaries, specifies uncertainties, and provides access to data collection methods is essential for comparability and for establishing reliable benchmarks in sustainable surgical practice. This study provides a comprehensive multicentre carbon footprint analysis for outpatient cataract surgery in Germany and offers a transparent framework that guides targeted reduction strategies.
SN - 0030-3755
SN - 1423-0267
ER -