The carbon footprint of epidural steroid injections: A pilot study.

Background: Epidural steroid injections are common procedures in physical medicine and rehabilitation practice. However, their environmental impact has not been characterized.

Objective: The primary aim is to estimate and compare the carbon footprint of two standard injection kits used to perform epidural steroid injections at a single academic institution. Secondary objectives were (1) to create a step-by-step guide for estimating the carbon footprint of materials and (2) to survey physicians on practice patterns and identify areas for improvement.

Design: Pilot study.

Setting: Academic medical center.

Participants: N/A.

Interventions: N/A.

Outcome Measures: Carbon emissions measured in CO equivalents (CO eq).

Methods: Using guidance from the Greenhouse Gas Protocol, the carbon footprint of the two kits was estimated by taking the sum of carbon emissions resulting from the production of the kit materials and the carbon emissions resulting from the waste disposal of the kit materials.

Results: The carbon footprint of the transforaminal epidural steroid injection (TFESI) kit was estimated at 1.328 kg CO eq. The carbon footprint of the interlaminar epidural steroid injection (ILESI) kit was estimated at 2.534 kg CO eq. For both kits, the carbon emissions resulting from the production of the kits were greater than the emissions resulting from disposal. The survey of interventionalists performing TFESI revealed all respondents required materials in addition to those provided in the standard epidural kit. Despite this, kit materials were typically wasted in 62% of respondents.

Conclusion: Creating a methodology for quantifying carbon emissions is the first step to reducing carbon emissions. Once emissions are measured, the health care industry can determine the most effective strategies for reducing its impact. Our analysis has shown that it is feasible to perform emissions calculations and delineates a clear method with publicly available resources. Solutions to reduce epidural injection carbon footprint waste may include improved kit customization.