Environmental Impact Labels for Surgical Devices: A Mixed-Methods Study of Surgeon Interpretation and Implementation Barriers.

INTRODUCTION

Operating rooms are among the most resource-intensive environments in hospitals, driven in part by extensive reliance on singe use surgical devices. Environmental impact labels (EILs) have been proposed to support sustainable decision-making; however, their interpretability and relevance in surgical workflows have not been systematically evaluated. We evaluated surgeons' perceptions of three EIL prototypes.

METHODS

We conducted a mixed-methods study of attending surgeons at a single academic medical center. Participants completed a structured survey assessing reactions to three EIL prototypes, followed by semi-structured interviews. Quantitative responses were analyzed using cumulative link mixed models and chi-square testing. Interview transcripts underwent inductive thematic analysis.

RESULTS

Thirty-two surgeons participated (median age 44.5 y; 59.4% male). Metrics such as carbon footprint, energy use, and emissions were consistently interpreted as intuitive, whereas abstract indicators (e.g., disability-adjusted life years) were frequently misunderstood. Label A and label B were rated higher in visual appeal than label C (P = 0.0034 and P = 0.0003), although no overall preference emerged (P = 0.1168). Four themes were identified: (1) label clarity and cognitive load, (2) interpretability of sustainability metrics, (3) perceptions of responsibility, and (4) the primacy of cost and device efficacy in decision-making.

CONCLUSIONS

Surgeons are receptive to environmental impact information when presented in clear, clinically interpretable formats. However, abstract metrics and limited control over device selection constrain the likelihood of behavior change. For EILs to influence practice, they must prioritize intuitive measures and be integrated within institutional procurement and cost frameworks.