Greener Surgery, Greener Hospital: Organizational Strategies for Carbon Footprint Reduction in Anesthesia and Perioperative Departments.

Environmental sustainability has become an increasingly important priority in healthcare, particularly in anesthesia and perioperative services, where energy use, anesthetic gases, disposable materials, procurement, and waste contribute substantially to environmental burden. This narrative review examines how isolated environmental practices can be transformed into structured organizational strategies that can support sustained implementation and wider organizational adoption. A structured literature search was conducted in PubMed/MEDLINE and Scopus between May and August 2026, followed by relevance assessment and narrative synthesis. Three complementary search domains addressed perioperative environmental sustainability, organizational implementation and governance, and hospital-level integration and scalability. Across both databases, 1,668 records were identified before deduplication, yielding 1,045 unique records for relevance assessment. Following relevance assessment and secondary appraisal, 40 publications were included in the final narrative synthesis. Evidence was synthesized across environmental impact, sustainable practices, organizational implementation, governance and measurement, and institutional scalability. The literature indicates that interventions such as reduced anesthetic-gas use, low-flow anesthesia, waste segregation, reusable equipment, supply optimization, and energy conservation can reduce environmental impact. However, durable improvement depends on organizational mechanisms including leadership, defined accountability, multidisciplinary engagement, standardized workflows, procurement alignment, education, audit, and performance measurement. Departmental initiatives in anesthesia and perioperative care may therefore serve as practical implementation environments in which effective strategies can be evaluated, standardized, and adapted across hospital services. Environmental sustainability in perioperative care should progress beyond isolated "green" practices toward integration within clinical governance and quality-improvement systems. The long-term objective is not only a greener operating room, but an organizational capacity for continuous environmental improvement while maintaining patient safety, quality of care, operational effectiveness, and responsible resource use.