Abstract
BACKGROUND: Climate change is a global health emergency, with substantial carbon emissions coming from health care. This study compares the carbon footprint of in-person versus virtual orthopaedic care at a large, urban, academic healthcare system. METHODS: Data were abstracted from the billing and claims database for orthopaedic clinic visits from 2018 to 2023 at a large, urban, academic medical center and its suburban satellite clinics. Carbon footprint per in-person visit was determined by combining emissions from supplies, facility energy use, and patient travel. The reduction in emissions of virtual visits was calculated compared with if all visits occurred in person. RESULTS: Overall, 508,394 orthopaedic clinic visits (94.3% in-person, 5.7% virtual) were recorded. The average in-person visit resulted in 7.12 vs. 0.026 kg CO2e for the average virtual visit. Actual carbon emissions were estimated to be 3,411,206 kg CO2e compared with 3,714,565 kg if all visits occurred in person (8.2% reduction). Most emissions (99.8%) were attributed to patient travel, with 0.2% coming from supplies and <0.1% from facility energy use. The peak of the COVID-19 pandemic in 2020 saw the greatest reduction in carbon emissions at 19.5%, with emissions increasing each year thereafter (8.3% reduction in 2023). CONCLUSION: The carbon footprint of clinic-based orthopaedic care is large and can be reduced by transitioning from in person to virtual care. Although virtual orthopaedic care has limitations, the environmental benefits are clear. Further research into virtual outpatient orthopaedic care should consider environmental impacts in addition to safety, effectiveness, and patient satisfaction.