Integrating environmental sustainability into operating room guidelines is feasible and necessary.

• Surgical practices significantly contribute to healthcare’s environmental impact, driven by disposables, energy use, and anesthetic emissions.
• A systematic review of 42 studies found the evidence quality was “very low” to “low,” yet consistent environmental threats were identified.

Surgical teams should consider actionable sustainability practices based on life cycle assessments to enhance both patient outcomes and reduce environmental footprints.

• Sustainability efforts could involve evaluating energy usage and transitioning to reusable materials where feasible.