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Surgical sustainability and hospital waste management: a narrative review with implementation pathways for Mexico
Surgical sustainability and hospital waste management: a narrative review with implementation pathways for Mexico
José A. Parra-Salazar 1 
, Daniel Mozo-Torres 2 , Valeria Herrera-Castañeda 2 , Edgar Grageda-Flores 2 , José M. Fernández-Rivero 2 , Carlos A. López-Bernal 3 , Arturo García-Galicia 4 , Álvaro J. Montiel-Jarquín 3 , Jorge Loría-Castellanos 5
1 General Management, Hospital de Especialidades de Puebla, Instituto Mexicano del Seguro Social (IMSS), Puebla, Pue., México; 2 Facultad de Medicina, Universidad de las Américas Puebla, San Andrés Cholula, Puebla, México; 3 Dirección de Educación e Investigación en Salud, Unidad Médica de Alta Especialidad Hospital de Especialidades de Puebla, Centro Médico Nacional Gral. de Div. Manuel Ávila Camacho, Instituto Mexicano del Seguro Social, Puebla de Zaragoza, México; 4 Dirección de Educación e Investigación en Salud, Unidad Médica de Alta Especialidad Hospital de Especialidades de Puebla, Centro Médico Nacional Gral. de Div. Manuel Ávila Camacho. Instituto Mexicano del Seguro Social, Puebla de Zaragoza, Pue., México; 5 Red Nacional de Educadores en Simulación Clínica, Ciudad de México, México
*Correspondence: Arturo García-Galicia. Email: neurogarciagalicia@yahoo.com.mx
Abstract
Background: Surgery creates a critical tension between patient safety, efficiency, and environmental sustainability. Objective: To synthesize evidence on surgical hospital waste management, preoperative testing, and sustainability strategies. Material and methods: A descriptive review was conducted using PubMed, SciELO, and Google Scholar, with MeSH/DeCS terms and Spanish- and English-language keywords related to medical and surgical waste, sustainability, and circular economy. The analysis addressed clinical and logistical context, environmental impact, regulations, hospital management, and circular economy strategies. Results: Surgical areas generate substantial waste from disposable supplies, packaging, medications, textiles, water, energy, and anesthetic gases. More than 80% is generated preoperatively. An operating room may generate up to 2,300 kg annually, accounting for 30% of total hospital waste; 85% is non-hazardous, whereas 15% requires special handling. Strategies include staff training, optimization of surgical packs, “green packs,” low-flow anesthesia, recovery of halogenated anesthetics, digital traceability, and Internet of Things technologies. Conclusions: Surgical sustainability should encompass the entire pathway from preoperative care to final waste disposal. Mexico should strengthen regulatory implementation, waste reduction and segregation, resource optimization, circular economy practices, and specific environmental and economic impact indicators.
Keywords: Waste management. Comprehensive waste management. Medical waste. Refuse disposal. Infectious biological waste.
