Background: Healthcare systems contribute substantially to global greenhouse gas emissions, with operating rooms representing one of the most carbon-intensive areas of clinical practice. Although awareness of environmentally sustainable practices in perioperative care is increasing, the extent to which knowledge and attitudes are associated with sustainable behaviors among operating room professionals remains unclear.
Methods: This multicenter cross-sectional survey with national scope was conducted among healthcare professionals working in operating room-related settings across Türkiye. Participants were recruited using a convenience sampling strategy. A structured, self-administered online questionnaire (based on self-reported responses) assessed knowledge, attitudes, and self-reported behaviors related to environmentally sustainable operating room practices. Knowledge, attitude, and behavior scores were analyzed as continuous variables. Correlation analyses and multivariable linear regression models were used to identify individual, professional, and institutional factors statistically associated with each domain.
Results: A total of 213 participants were included. Mean knowledge, attitude, and behavior scores were 6.23 ± 2.44, 19.0 ± 6.0, and 22.0 ± 6.0, respectively. Knowledge scores were positively associated with anesthesiology-related affiliation and specific clinical exposures and inversely associated with age and years of professional experience. Attitude scores were associated with obstetric operating room experience, prior sustainability-related training, and peer- and literature-based information sources. Behavior scores were independently associated with both knowledge and attitude scores and with the reported presence of an institutional carbon footprint-related training program. The reported presence of a formal institutional carbon footprint policy was not associated with higher knowledge or attitude scores and showed a negative association with knowledge in adjusted analyses.
Conclusion: Operating room professionals in this multicenter survey demonstrated limited-to-moderate awareness and generally favorable attitudes toward environmental sustainability; however, variability in self-reported sustainable practices was observed. Knowledge and institutional variables were statistically associated with behavior scores, although causal inferences cannot be made. Given the convenience sampling design and reliance on self-reported data, findings should be interpreted with caution. These findings highlight the complexity of sustainability implementation in anesthesia and perioperative care and support the need for further implementation-focused and longitudinal research.
Keywords: Anesthesia; Carbon footprint; Climate change; Environmental health; Environmental sustainability; Health professionals; Operating room; Perioperative care.
© 2026. The Author(s).