Background: Surgery is contributing to the climate crisis, not least in the outpatient sector. The present publication aims to identify the challenges this poses, and to provide clear, preferably evidence-based recommendations on environmental protection while simultaneously reducing costs., Method: Narrative review with a non-systematic search and selection in PubMed/MEDLINE and grey area literature as well as expert interviews., Results: Numerous primary articles, evidence syntheses, practical recommendations for action and checklists were identified and two experts were interviewed. Environmental issues were identified in the production and procurement, transport of people and goods, usage of materials, pharmaceuticals including anesthetic gases and energy consumption in the outpatient practice and also in disposal, recycling, and sterilization. High-quality publications do not describe a lack of knowledge on alternatives but on a lack of implementation in clinical practice. Therefore, the identified issues were classified in the 5‑R scheme (reduce, reuse, recycle, rethink, research) to present recommendations for action, which are synergetic in terms of cost reduction, patient and staff satisfaction. Furthermore, changes in regulatory frameworks are discussed., Conclusion: Outpatient surgery comes with relevant consumption of resources and carbon emissions. There are numerous opportunities for action that combine environmental protection with cost reduction as well as patient and staff satisfaction. Incentives, guidelines, and legal framework conditions are needed for comprehensive environmental protection in the private sector., (© The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2023.)