In this study, the annual energy consumptions of four different heating, ventilation and air conditioning (HVAC) systems serving to operation rooms (ORs) located at five different cities (Izmir, Antalya, Istanbul, Ankara and, Erzurum) in Turkey are analyzed. The study is performed for four different HVAC systems: (a) 100% fresh air system (System I), (b) 100% fresh air with half air volume rate at night period (System II), (c) 100% fresh air with half air volume rate at night period and heat recovery unit (System III), (d) 50% fresh air with half air volume rate at night period and with heat recovery and mixing units (System IV). Life cycle cost (LCC) for 20 years life span is calculated for the considered systems. It is found that System IV considerably reduces energy consumption and it is economically proper for the considered cities. The rate of energy consumption and LCC reductions are greater for the cities with extreme climate condition having relatively low specific humidity ratio. Using System IV instead of System I reduces OR energy consumption by 74% for the city of Erzurum which has a cold and dry climate. (C) 2011 Elsevier B.V. All rights reserved.