Background <p>Waste management in hospitals is an important factor with respect to environmental sustainability. Surgical waste disposal causes substantial CO₂ emissions. In addition to recycling, waste reduction is an essential strategy for reducing emissions. Reusable textiles offer a promising approach to decrease waste in operating rooms.</p> Objective <p>Assessment of reusable textiles in terms of waste generation, operational processes and staff acceptance.</p> Material and methods <p>This prospective observational study compared waste generation when using disposable or reusable drapes in 272 orthopedic and trauma operations over periods of 2 weeks each. Waste volume and weight as well as preparation, clean-up and surgery times were recorded and statistically analyzed. Surgical staff were then asked about their experiences with reusable textiles.</p> Results and discussion <p>The use of disposable drapes resulted in 93.59l (± 75.16l) and 5.32kg (± 2.04kg) of hospital-specific waste per operation. The introduction of reusable drapes reduced waste volume by 40% and weight by 34% (<i>p</i> &lt; 0.001) without affecting preparation, clean-up or surgical time. Of the staff 96% considered the use of reusable textiles to be unproblematic. The use of reusable textiles significantly reduces waste in operating rooms without affecting workflows and is supported by operating room staff. The implementation represents a&#xa0;practical and effective measure towards greater sustainability in operating rooms.</p>