Green operating theatres: A review of strategies, challenges, and future directions for sustainable surgical care

Healthcare plays an essential role in protecting health, yet it also contributes significantly to environmental harm. Current estimates suggest that healthcare systems account for about 5% of global greenhouse gas emissions. Within hospitals, operating theatres are among the largest contributors. They consume large amounts of energy, depend heavily on single-use devices (SUDs), generate substantial waste, and release anaesthetic gases with high global warming potential.This review examines the concept of green operating theatres and summarises practical, evidence-based strategies to reduce their environmental impact without compromising patient safety or clinical outcomes. A comprehensive literature search was conducted across major biomedical databases to identify evidence on environmental impact of operating theatre (OT) services and sustainable OT practices. Heating, ventilation, and air conditioning (HVAC) systems, SUDs, anaesthetic gases, excessive energy and water use, and inefficient workflow designs are identified as the major factors causing environmental impact. Specific sustainability options like 5 ‘R’s framework, circular economy principle, and lean management are also explored.Focused interventions like optimisation of HVAC systems, transition to reusable instruments, reduced waste generation and improved waste segregation, water conservation, light emitting diode (LED) lighting, low flow anaesthesia and TIVA, and elimination of high impact agents like desflurane are discussed. The role of emerging technologies like artificial intelligence (AI), internet of things (IoT), and renewable energy options in increasing sustainability is also highlighted. Implementation challenges such as infection control anxiety, financial constraints, behavioural inertia, and regulatory limitations are critically examined.This review concludes that transitioning to green OT is not only an environmentally sustainable initiative but also a mean to achieve operational integrity and financial efficiency. A coordinated, multidisciplinary approach, supported by leadership, technological advancement, and policy reform is essential for achieving sustainable and future-ready surgical care.