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Sharif K, de Santiago ER, David P, Afek A, Gralnek IM, Ben-Horin S, Lahat A. Ecogastroenterology: cultivating sustainable clinical excellence in an environmentally conscious landscape. Lancet Gastroenterol Hepatol 2024; 9:550-563. [PMID: 38554732 DOI: 10.1016/s2468-1253(23)00414-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 04/02/2024]
Abstract
Gastrointestinal practices, especially endoscopy, have a substantial environmental impact, marked by notable greenhouse gas emissions and waste generation. As the world struggles with climate change, there emerges a pressing need to re-evaluate and reform the environmental footprint within gastrointestinal medicine. The challenge lies in finding a harmonious balance between ensuring clinical effectiveness and upholding environmental responsibility. This task involves recognising that the most significant reduction in the carbon footprint of endoscopy is achieved by avoiding unnecessary procedures; addressing the use of single-use endoscopes and accessories; and extending beyond the procedural suites to include clinics, virtual care, and conferences, among other aspects of gastrointestinal practice. The emerging digital realm in health care is crucial, given the potential environmental advantages of virtual gastroenterological care. Through an in-depth analysis, this review presents a path towards sustainable gastrointestinal practices, emphasising integrated strategies that prioritise both patient care and environmental stewardship.
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Affiliation(s)
- Kassem Sharif
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Department of Internal Medicine B, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Enrique Rodriguez de Santiago
- Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, CIBERehd, ISCIII, Madrid, Spain
| | - Paula David
- Department of Internal Medicine B, Sheba Medical Centre, Ramat Gan, Israel
| | - Arnon Afek
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ian M Gralnek
- Ellen and Pinchas Mamber Institute of Gastroenterology and Hepatology, Emek Medical Centre, Afula, Israel; Rappaport Faculty of Medicine Technion Israel Institute of Technology, Haifa, Israel
| | - Shomron Ben-Horin
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Lahat
- Department of Gastroenterology, Sheba Medical Centre, Ramat Gan, Israel; Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Gunasekaran S, Szava-Kovats A, Battey T, Gross J, Picano E, Raman SV, Lee E, Bissell MM, Alasnag M, Campbell-Washburn AE, Hanneman K. Cardiovascular Imaging, Climate Change, and Environmental Sustainability. Radiol Cardiothorac Imaging 2024; 6:e240135. [PMID: 38900024 PMCID: PMC11211952 DOI: 10.1148/ryct.240135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 05/03/2024] [Accepted: 05/31/2024] [Indexed: 06/21/2024]
Abstract
Environmental exposures including poor air quality and extreme temperatures are exacerbated by climate change and are associated with adverse cardiovascular outcomes. Concomitantly, the delivery of health care generates substantial atmospheric greenhouse gas (GHG) emissions contributing to the climate crisis. Therefore, cardiac imaging teams must be aware not only of the adverse cardiovascular health effects of climate change, but also the downstream environmental ramifications of cardiovascular imaging. The purpose of this review is to highlight the impact of climate change on cardiovascular health, discuss the environmental impact of cardiovascular imaging, and describe opportunities to improve environmental sustainability of cardiac MRI, cardiac CT, echocardiography, cardiac nuclear imaging, and invasive cardiovascular imaging. Overarching strategies to improve environmental sustainability in cardiovascular imaging include prioritizing imaging tests with lower GHG emissions when more than one test is appropriate, reducing low-value imaging, and turning equipment off when not in use. Modality-specific opportunities include focused MRI protocols and low-field-strength applications, iodine contrast media recycling programs in cardiac CT, judicious use of US-enhancing agents in echocardiography, improved radiopharmaceutical procurement and waste management in nuclear cardiology, and use of reusable supplies in interventional suites. Finally, future directions and research are highlighted, including life cycle assessments over the lifespan of cardiac imaging equipment and the impact of artificial intelligence tools. Keywords: Heart, Safety, Sustainability, Cardiovascular Imaging Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Suvai Gunasekaran
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
| | - Andrew Szava-Kovats
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
| | - Thomas Battey
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
| | - Jonathan Gross
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
| | - Eugenio Picano
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
| | - Subha V. Raman
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
| | - Emil Lee
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
| | - Malenka M. Bissell
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
| | - Mirvat Alasnag
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
| | - Adrienne E. Campbell-Washburn
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
| | - Kate Hanneman
- From the Biomedical Imaging Research Institute, Cedars-Sinai Medical
Center, Los Angeles, Calif (S.G.); Department of Radiology, Feinberg School of
Medicine, Northwestern University, Chicago, Ill (S.G.); Department of Nuclear
Medicine, Peter Lougheed Hospital, Alberta Health Services, Calgary, Canada
(A.S.K.); Department of Radiology, University of Calgary, Calgary, Canada
(A.S.K.); Department of Radiology & Medical Imaging, University of
Virginia, Charlottesville, Va (T.B.); Department of Radiology, Texas
Children’s Hospital, Baylor School of Medicine, Houston, Tex (J.G.);
Division of Cardiology, University Clinical Center of Serbia, University of
Belgrade, Belgrade, Serbia (E.P.); OhioHealth, Columbus, Ohio (S.V.R.); Langley
Memorial Hospital, British Columbia, Canada (E.L.); Department of Biomedical
Imaging Science, University of Leeds, Leeds, United Kingdom (M.M.B.); Cardiac
Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia (M.A.);
Cardiovascular Branch, Division of Intramural Research, National Heart, Lung,
and Blood Institute, National Institutes of Health, Bethesda, Md (A.E.C.W.);
Joint Department of Medical Imaging, Peter Munk Cardiac Centre and Toronto
General Hospital Research Institute, University Medical Imaging Toronto,
University Health Network (UHN), 585 University Avenue, 1 PMB-298, Toronto, ON,
Canada M5G 2N2 (K.H.); and Department of Medical Imaging, University of Toronto,
Toronto, Canada (K.H.)
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Friedericy HJ, Friedericy AF, de Weger A, van Dorp ELA, Traversari RAAL, van der Eijk AC, Jansen FW. Effect of unidirectional airflow ventilation on surgical site infection in cardiac surgery: environmental impact as a factor in the choice for turbulent mixed air flow. J Hosp Infect 2024; 148:51-57. [PMID: 38537748 DOI: 10.1016/j.jhin.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Surgical site infection (SSI) in the form of postoperative deep sternal wound infection (DSWI) after cardiac surgery is a rare, but potentially fatal, complication. In addressing this, the focus is on preventive measures, as most risk factors for SSI are not controllable. Therefore, operating rooms are equipped with heating, ventilation and air conditioning (HVAC) systems to prevent airborne contamination of the wound, either through turbulent mixed air flow (TMA) or unidirectional air flow (UDAF). AIM To investigate if the risk for SSI after cardiac surgery was decreased after changing from TMA to UDAF. METHODS This observational retrospective single-centre cohort study collected data from 1288 patients who underwent open heart surgery over 2 years. During the two study periods, institutional SSI preventive measures remained the same, with the exception of the type of HVAC system that was used. FINDINGS Using multi-variable logistic regression analysis that considered confounding factors (diabetes, obesity, duration of surgery, and re-operation), the hypothesis that TMA is an independent risk factor for SSI was rejected (odds ratio 0.9, 95% confidence interval 0.4-1.8; P>0.05). It was not possible to demonstrate the preventive effect of UDAF on the incidence of SSI in patients undergoing open heart surgery when compared with TMA. CONCLUSION Based on these results, the use of UDAF in open heart surgery should be weighed against its low cost-effectiveness and negative environmental impact due to high electricity consumption. Reducing energy overuse by utilizing TMA for cardiac surgery can diminish the carbon footprint of operating rooms, and their contribution to climate-related health hazards.
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Affiliation(s)
- H J Friedericy
- Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands.
| | - A F Friedericy
- Department of Health Sciences, Free University of Amsterdam, Amsterdam, The Netherlands
| | - A de Weger
- Department of Cardiothoracic Surgery, Leiden University Medical Centre, Leiden, The Netherlands
| | - E L A van Dorp
- Department of Anaesthesiology, Leiden University Medical Centre, Leiden, The Netherlands
| | | | - A C van der Eijk
- Operating Room Department and Central Sterile Supply Department, Leiden University Medical Centre, Leiden, The Netherlands
| | - F W Jansen
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands; Faculty of Biomedical Engineering, Delft University of Technology, Delft, The Netherlands
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Roscioli R, Wyllie T, Neophytou K, Dent L, Lowen D, Tan D, Dunne B, Hodgson R. How we can reduce the environmental impact of our operating theatres: a narrative review. ANZ J Surg 2024; 94:1000-1010. [PMID: 37985608 DOI: 10.1111/ans.18770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/03/2023] [Accepted: 10/29/2023] [Indexed: 11/22/2023]
Abstract
Climate change is projected to become the leading cause of adverse health outcomes globally, and the healthcare system is a key contributor. Surgical theatres are three to six times more pollutant than other hospital areas, and produce anywhere from a fifth to a third of total hospital waste. Hospitals are increasingly expected to make operating theatres more sustainable, however guidelines to improve environmental sustainability are lacking, and previous research takes a narrow approach to operative sustainability. This paper presents a narrative review that, following a 'review of reviews' approach, aims to summarize the key recommendations to improve the environmental sustainability of surgical theatres. Key domains of discussion identified across the literature included minimisation of volatile anaesthetics, reduction of operating theatre power consumption, optimisation of surgical approach, re-use and re-processing of surgical instruments, waste management, and research, education and leadership. Implementation of individual items in these domains has seen significant reductions in the environmental impact of operative practice. This comprehensive summary of recommendations lays the framework from which providers can assess the sustainability of their practice and for the development of encompassing guidelines to build an environmentally sustainable surgical service.
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Affiliation(s)
- Robert Roscioli
- Department of Surgery, University of Melbourne, Epping, Victoria, Australia
| | - Tracey Wyllie
- Division of Surgery, Northern Health, Epping, Victoria, Australia
| | | | - Lana Dent
- Division of Surgery, Northern Health, Epping, Victoria, Australia
| | - Darren Lowen
- Department of Anaesthesia & Perioperative Medicine, Northern Health, Epping, Victoria, Australia
- Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia
| | - David Tan
- Department of Anaesthesia & Perioperative Medicine, Northern Health, Epping, Victoria, Australia
| | - Ben Dunne
- Department of Surgery, Royal Melbourne Hospital, Parkville, Victoria, Australia
- Department of Surgery, Peter Macallum Cancer Centre, Parkville, Victoria, Australia
- Department of Surgery, University of Melbourne, Parkville, Victoria, Australia
| | - Russell Hodgson
- Department of Surgery, University of Melbourne, Epping, Victoria, Australia
- Division of Surgery, Northern Health, Epping, Victoria, Australia
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55
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Leow L, Tam JKC, Kee PP, Zain A. Healthcare sustainability in cardiothoracic surgery. ANZ J Surg 2024; 94:1059-1064. [PMID: 38345130 DOI: 10.1111/ans.18899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 06/19/2024]
Abstract
BACKGROUND Climate change is the greatest threat to human health. Cardiothoracic patients suffer direct consequences from poor environmental health and we have a vested interest to address this in our practice. As leaders of complex high-end surgery, we are uniquely positioned to effect practical and immediate changes to significantly pare down emissions within the operating theatre, outside the operating theatre and beyond the confines of the hospital. METHODS We aim to spotlight this pressing issue, take stock of our current efforts, and encourage fellow specialists to drive this agenda. RESULTS Sustainability in healthcare needs to be formalized as part of the core curriculum in surgical training and awareness generated via carbon audits and life cycle analyses. Practical actions such as reducing unnecessary equipment usage, choosing reusable equipment over single use disposables, judicious use of investigations rooted in clinical reasoning and sharing of resources across services and health systems help reduce the carbon output of our specialty. CONCLUSION The 'Triple Bottom Line' serves as a good template to calibrate efforts that balance quality against environmental costs. More can be done to advocate for and find solutions for sustainable healthcare with cardiothoracic surgery.
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Affiliation(s)
- Lowell Leow
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, Singapore
| | - John Kit Chung Tam
- Department of Cardiac, Thoracic and Vascular Surgery, National University Heart Centre Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Poh Pei Kee
- Department of Anaesthesia, National University Hospital Singapore, Singapore
| | - Amanda Zain
- Department of Paediatrics, Khoo Teck Puat National University Children's Medical Institute, National University Hospital Singapore, Singapore
- Centre for Sustainable Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Ogeron P, Boukebous B, Desender A, Massard-Combe P, Vorimore C, Guillon P. Average total weight of surgical waste and CO 2 carbon footprint of orthopedic surgery in France, estimated on the basis of a representative panel. Orthop Traumatol Surg Res 2024:103910. [PMID: 38782115 DOI: 10.1016/j.otsr.2024.103910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Reduction of waste and carbon footprint can be optimized. Awareness of carbon sources and quantification of the waste are two key parameters. To our knowledge, there is no study in France on waste production by the surgical team during the operation in orthopedic surgery, in a global scope. Therefore, we performed an observational investigation aiming to: (1) quantify and characterize the weight of the wastes generated after a panel of orthopedic procedures, (2) calculate the CO2 footprint generated by these wastes and extrapolate the figure at the national scale. HYPOTHESIS Waste production is highly variable according to the types of procedures and infectious clinical waste is still a predominant source of waste and CO2 emission. MATERIALS AND METHODS It is a comparative and prospective study in which a total of 14 procedures were selected as a representative panel: arthroplasties (hip, knee), spine fusions, arthroscopic procedures (shoulder, knee), nerve release, forefoot osteotomies, trauma procedures. The main outcome was the average total weight of waste for each of the fourteen categories (280 measurements: 140 times 2, at the end of each procedure), expressed in kilograms (kg), and the proportions of infectious clinical waste (ICW) and household wastes (HW), expressed in percentages. Ten measures were prospectively recorded for each type of procedure in a single teaching hospital from January to September 2022. The theoretical carbon footprint generated by the treatment of the wastes was estimated in kilograms of CO2 equivalent (KgEqCO2). The national extrapolation of the carbon footprint was performed by collecting the total number of procedures in France in 2021 using the VisuChir tool. RESULTS A total of 937kg of waste were produced for the 140 procedures, amongst which 514kg of ICW (54.8%) and 423kg of HW (45.2%). The overall median waste weight was 5.9kg (Q1: 4.4, Q3: 8.1), ranging from 1.8kg to 18.3kg. The overall median waste weight for HW was 2.8kg (Q1: 2.5, Q3: 3.4), ranging from 1.8kg to 17.8kg. The overall median waste weight for ICW was 3.8kg (Q1: 2.7, Q3: 4.8), ranging from 0.8kg to 7.2kg. The knee surgeries were responsible for the heaviest waste weight; the least waste-productive procedures were the foot and the carpal tunnel release. The median proportions of ICW varied from 39% for the total knee replacements to 72% for the femoral nails. There was a significant inverse correlation between the total waste weight and the proportion of ICW: r=-0.47, p<10-4. The total median estimated carbon footprint was 4.3KgCO2Eq (Q1: 3.1, Q3: 5.8), ranging from 1.59KgCO2Eq (Q1: 1.5, Q3: 1.8) and 7.07KgCO2Eq (Q1: 6.7, Q3: 8.17). The total median estimated carbon footprint was 3.5KgCO2Eq for ICW (Q1: 2.5, Q3: 4.5) and 0.76KgCO2Eq (Q1: 0.54, Q3: 1.3) for HW. The national median estimated carbon footprint was 10.1 million KgEqCO2 in 2021 for orthopedic surgery. CONCLUSION Our study revealed that in most cases more than half of the wastes were ICW. The total estimated national carbon footprint for orthopedic procedures was 10 million kilograms. The reduction of the ICW constitutes a cornerstone, as they are responsible for more carbon emissions. LEVEL OF EVIDENCE III; prospective comparative observational in vivo study.
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Affiliation(s)
- Pierre Ogeron
- Groupe hospitalier intercommunal Le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France.
| | - Baptiste Boukebous
- Inserm, UMR 1153, équipe ECAMO, CRESS (Centre of Research in Epidemiology and StatisticS), université Paris-Cité, Paris, France; Service de chirurgie orthopédique et traumatologique, Beaujon/Bichat, université Paris-Cité, AP-HP, Paris, France
| | - Anthony Desender
- Groupe hospitalier intercommunal Le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - Philippe Massard-Combe
- Groupe hospitalier intercommunal Le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - Camille Vorimore
- Groupe hospitalier intercommunal Le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
| | - Pascal Guillon
- Groupe hospitalier intercommunal Le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France
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Maheshwari K, Epanomeritakis IE, Hills S, Hindocha S. Carbon footprint of a laser unit: a study of two centres in the UK. Lasers Med Sci 2024; 39:134. [PMID: 38771416 DOI: 10.1007/s10103-024-04081-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 05/12/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE Climate change has serious consequences for our wellbeing. Healthcare systems themselves contribute significantly to our total carbon footprint, of which emissions from surgical practice are a major component. The primary sources of emissions identified are anaesthetic gases, disposal of single-use equipment, energy usage, and travel to and from clinical areas. We sought to quantify the waste generated by laser surgery which, to our knowledge, has not been previously reported. METHODS The carbon footprint of two laser centres operating within the United Kingdom were measured. The internationally recognised Greenhouse Gas Protocol was used as a guiding framework to classify sources of waste and conversion factors issued by the UK government were used to quantify emissions. RESULTS The total carbon footprints per day at each unit were 299.181 carbon dioxide equivalents (kgCo2eq) and 121.512 kgCO2eq, respectively. We found the carbon footprint of individual laser treatments to be approximately 15 kgCO2eq per procedure. The biggest overall contributor to the carbon footprint was found to be the emissions generated from staff, patient and visitor travel. This was followed by electricity usage, and indirect emissions from physical waste and laundry. CONCLUSIONS The carbon footprint of laser procedures was considerably less than the average surgical operation in the UK. This initial study measures the carbon footprint of a laser center in a clinical setting and allows us to identify where improvements can be made to eventually achieve a net carbon zero health care system.
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Affiliation(s)
- Kavish Maheshwari
- Department of Plastic Surgery, Bedford Hospital NHS trust, Bedford, UK.
| | | | | | - Sandip Hindocha
- Department of Plastic Surgery, Bedford Hospital NHS trust, Bedford, UK
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Lans JLA, Mathijssen NMC, Bode A, van den Dobbelsteen JJ, van der Elst M, Luscuere PG. What is the effect of reducing the air change rate on the ventilation effectiveness in ultra-clean operating rooms? J Hosp Infect 2024; 147:115-122. [PMID: 38423130 DOI: 10.1016/j.jhin.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/20/2024] [Accepted: 02/06/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The operating room (OR) department is one of the most energy-intensive departments of a hospital. The majority of ORs in the Netherlands have an air-handling installation with an ultra-clean ventilation system. However, not all surgeries require an ultra-clean OR. AIM To determine the effect of reducing the air change rate on the ventilation effectiveness in ultra-clean ORs. METHODS Lower air volume ventilation effectiveness (VELv) of conventional ventilation (CV), controlled dilution ventilation (cDV), temperature-controlled airflow (TcAF) and unidirectional airflow (UDAF) systems were evaluated within a 4 × 4 m measuring grid of 1 × 1 m. The VELv was defined as the recovery degree (RD), cleanliness recovery rate (CRR) and air change effectiveness (ACE). FINDINGS The CV, cDVLv and TcAFLv ventilation systems showed a comparable mixing character in all areas (A, B and AB) when reducing the air change rate to 20/h. Ventilation effectiveness decreased when the air change rate was reduced, with the exception of the ACE. At all points for the UDAF-2Lv and at the centre point (C3) of the TcAFLv, higher RD10Lv and CRRLv were measured when compared with the other examined ventilation systems. CONCLUSIONS The ventilation effectiveness decreased when an ultra-clean OR with an ultra-clean ventilation air-supply system was switched to an air change rate of 20/h. Reducing the air change rate in the OR from an ultra-clean OR to a generic OR will reduce the recovery degree (RD10) by a factor of 10-100 and the local air change rate (CRR) by between 42% and 81%.
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Affiliation(s)
- J L A Lans
- Faculty Architecture and the Built Environment, Delft University of Technology, Delft, The Netherlands.
| | - N M C Mathijssen
- RHOC, Reinier Haga Orthopaedic Center, Zoetermeer, The Netherlands; Department of Orthopaedic Surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - A Bode
- Expert/Advisor Healthcare and Construction, IJsselstein, The Netherlands
| | - J J van den Dobbelsteen
- Faculty of Mechanical Engineering (ME), Delft University of Technology, Delft, The Netherlands
| | - M van der Elst
- Faculty of Mechanical Engineering (ME), Delft University of Technology, Delft, The Netherlands; Department of Trauma surgery, Reinier de Graaf Hospital, Delft, The Netherlands
| | - P G Luscuere
- Faculty Architecture and the Built Environment, Delft University of Technology, Delft, The Netherlands
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Or Z, Seppänen AV. The role of the health sector in tackling climate change: A narrative review. Health Policy 2024; 143:105053. [PMID: 38537397 DOI: 10.1016/j.healthpol.2024.105053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/08/2024] [Accepted: 03/12/2024] [Indexed: 04/20/2024]
Abstract
Climate change is one of the largest threats to population health and has already affected the ecosystem, food production, and health and wellbeing of populations all over the world. The healthcare sector is responsible for around 5 % of greenhouse gas emissions worldwide and can play a key role in reducing global warming. This narrative review summarized the information on the role of healthcare systems in addressing climate change and strategies for reducing its negative impact to illustrate different types of actions that can support the ecological transformation of healthcare systems to help reaching sustainable development goals. A wide range of green interventions are shown to be effective to reduce the carbon footprint of healthcare and can have a meaningful impact if implemented systematically. However, these would not suffice unless accompanied by systemic mitigation strategies altering how healthcare is provided and consumed. Sustainable healthcare strategies such as reducing waste and low-value care will have direct benefits for the environment while improving economic and health outcomes. The healthcare sector has a unique opportunity to leverage its position and resources to provide a comprehensive strategy for fighting climate change and improving population health and the environment on which it depends.
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Affiliation(s)
- Zeynep Or
- Institut de recherche et documentation en économie de la santé (IRDES), France.
| | - Anna-Veera Seppänen
- Institut de recherche et documentation en économie de la santé (IRDES), France
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Nadig RR, Deepak B, Neelamegam V, Moussa G, Raman R. Global warming impact of fluorinated gases in ophthalmic surgeries at a tertiary eye center in India. Indian J Ophthalmol 2024; 72:692-696. [PMID: 38153979 PMCID: PMC11168549 DOI: 10.4103/ijo.ijo_1775_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/07/2023] [Accepted: 10/25/2023] [Indexed: 12/30/2023] Open
Abstract
PURPOSE Global warming is one of the greatest health threats of the 21 st century. The ophthalmic sector contributes to the emission of greenhouse gases, thus altering the natural environment. There is currently no data on global emissions of fluorinated gases in ophthalmic surgery. This retrospective study from 2017 to 2021 aims to report the carbon dioxide (CO 2 ) equivalence of sulfur hexafluoride (SF 6 ), hexafluoroethane (C 2 F 6 ), and octafluoropropane (C 3 F 8 ) at a tertiary eye center. METHODS Data collected from 1842 surgical procedures that used injections of fluorinated gases were analyzed. Environmental impact (global warming potential over 100 years) was calculated by converting milliliters to grams by using modified ideal gas law at standard temperature and pressure for the canisters and then to their CO 2 equivalence. RESULTS Though 70% of surgeries used C 3 F 8 , the least greenhouse effect causing fluorinated gas, the total carbon emission was 1.4 metric tons. The most common indication was macular hole surgery (36.86%). CONCLUSION This study paves a step toward analyzing the problem statement, thus awakening us to contemplate options to make ophthalmic surgeries greener.
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Affiliation(s)
- Ramya R Nadig
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - B Deepak
- Department of Ophthalmology, Dr. Agarwal’s Health Care Ltd., Raaj Towers, Mogappair West, Chennai, Tamil Nadu, India
| | - Vidya Neelamegam
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - George Moussa
- Department of Ophthalmology, Manchester Royal Eye Hospital, Oxford Road, Manchester, UK
| | - Rajiv Raman
- Shri Bhagwan Mahavir Vitreoretinal Services, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
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Hantel A, Marron JM, Abel GA. Establishing and Defining an Approach to Climate Conscious Clinical Medical Ethics. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2024:1-14. [PMID: 38635462 DOI: 10.1080/15265161.2024.2337418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
An anthropocentric scope for clinical medical ethics (CME) has largely separated this area of bioethics from environmental concerns. In this article, we first identify and reconcile the ethical issues imposed on CME by climate change including the dispersion of related causes and effects, the transdisciplinary and transhuman nature of climate change, and the historic divorce of CME from the environment. We then establish how several moral theories undergirding modern CME, such as virtue ethics, feminist ethics, and several theories of justice, promote both a flourishing of human medical practice and the environment. We conclude by defining an expanded the scope of CME as inclusive of not only patients, families, physicians, and other health professionals but other humans, non-humans, and their shared environment. We then apply this scope and theory to a widely used framework for applying CME, the Four Topics model, to construct a climate conscious approach to CME.
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Corrente A, Pace MC, Fiore M. Climate change and human health: Last call to arms for us. World J Clin Cases 2024; 12:1870-1874. [PMID: 38660546 PMCID: PMC11036518 DOI: 10.12998/wjcc.v12.i11.1870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/03/2024] [Accepted: 03/22/2024] [Indexed: 04/11/2024] Open
Abstract
Climate change, now the foremost global health hazard, poses multifaceted challenges to human health. This editorial elucidates the extensive impact of climate change on health, emphasising the increasing burden of diseases and the exacerbation of health disparities. It highlights the critical role of the healthcare sector, particularly anaesthesia, in both contributing to and mitigating climate change. It is a call to action for the medical community to recognise and respond to the health challenges posed by climate change.
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Affiliation(s)
- Antonio Corrente
- Department of Anaesthesiology and Intensive Care Medicine, The Anastasia Guerriero Hospital, Marcianise 81025, Caserta, Italy
| | - Maria Caterina Pace
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
| | - Marco Fiore
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, Naples 80138, Italy
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Issa R, Forbes C, Baker C, Morgan M, Womersley K, Klaber B, Mulcahy E, Stancliffe R. Sustainability is critical for future proofing the NHS. BMJ 2024; 385:e079259. [PMID: 38604667 DOI: 10.1136/bmj-2024-079259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Affiliation(s)
- Rita Issa
- School of Global Development, University of East Anglia, Norwich, UK
- FXB Center for Health and Human Rights, T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Institute for Global Health, University College London, London, UK
| | - Callum Forbes
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - Catherine Baker
- Royal Sussex County Hospital, University Hospitals Sussex, Brighton, UK
| | - Matt Morgan
- Cardiff University, Cardiff, UK
- University Hospital of Wales, Cardiff, UK
- Curtin University, Perth, WA, Australia
| | - Kate Womersley
- The George Institute for Global Health at Imperial College London, London, UK
- NHS Lothian, Scotland, UK
| | - Bob Klaber
- Imperial College Healthcare NHS Trust, London, UK
- School of Public Health, Imperial College London, London, UK
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Barker NDJ, Tukkers C, Nelissen RGHH. What's Important (Arts and Humanities): Shouldn't Our GOAL! Be to Find a Better Way? J Bone Joint Surg Am 2024; 106:639-642. [PMID: 38127839 PMCID: PMC10980174 DOI: 10.2106/jbjs.23.00828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
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van Nieuwenhuizen KE, Both IGIA, Porte PJ, van der Eijk AC, Jansen FW. Environmental sustainability and gynaecological surgery: Which factors influence behaviour? An interview study. BJOG 2024; 131:716-724. [PMID: 37973607 DOI: 10.1111/1471-0528.17709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/10/2023] [Accepted: 10/21/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To assess the various factors that influence environmentally sustainable behaviour in gynaecological surgery and examine the differences between gynaecologists and residents. DESIGN An interview study. SETTING Academic and non-academic hospitals in the Netherlands. POPULATION Gynaecologists (n = 10) and residents (n = 6). METHODS Thematic analysis of semi-structured interviews to determine the various factors that influence environmentally sustainable behaviour in gynaecological surgery and to examine the differences between gynaecologists and residents. By using the Desmond framework and the COM-B BCW, both organisational and individual factors related to behaviour were considered. MAIN OUTCOME MEASURES Factors that influence environmentally sustainable behaviour. RESULTS Awareness is increasing but practical knowledge is insufficient. It is crucial to integrate education on the environmental impact of everyday decisions for residents and gynaecologists. Gynaecologists make their own choices but residents' autonomy is limited. There is the necessity to provide environmentally sustainable surgical equipment without compromising other standards. There is a need for a societal change that encourages safe and open communication about environmental sustainability. To transition to environmentally sustainable practices, leadership, time, collaboration with the industry and supportive regulatory changes are essential. CONCLUSION This study lays the groundwork for promoting more environmentally sustainable behaviour in gynaecological surgery. The key recommendations, addressing hospital regulations, leadership, policy revisions, collaboration with the industry, guideline development and education, offer practical steps towards a more sustainable healthcare system. Encouraging environmentally sustainable practices should be embraced to enhance the well-being of both our planet and our population, driving us closer to a more environmentally sustainable future in healthcare.
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Affiliation(s)
| | - Ingena G I A Both
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Petra J Porte
- Department Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Anne C van der Eijk
- Operating Room Department and Central Sterile Supply Department, Leiden University Medical Centre, Leiden, The Netherlands
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Frank Willem Jansen
- Department of Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of BioMechanical Engineering, Delft University of Technology, Delft, The Netherlands
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Spinos D, Doshi J, Garas G. Delivering a net zero National Health Service: where does otorhinolaryngology - head and neck surgery stand? J Laryngol Otol 2024; 138:373-380. [PMID: 37795753 DOI: 10.1017/s0022215123001780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
OBJECTIVE The National Health Service (NHS) recognised the risk to public health brought by climate change by launching the Greener NHS National Programme in 2020. These organisational changes aim to attain net zero direct carbon emissions. This article reviews the literature on initiatives aimed at mitigating the environmental impact of ENT practice. METHOD Systematic review of the literature using scientific, healthcare and general interest (public domain) databases. RESULTS The initiatives reviewed can be broken down into strategies for mitigating the carbon footprint of long patient stay, use of operative theatres and healthcare travel. The carbon footprint of in-patient stay can be mitigated by a shift towards day-case surgery. The ENT community is currently focused on the reduction of theatre waste and the use of disposable instruments. Furthermore, supply chains and healthcare delivery models are being redesigned to reduce travel. CONCLUSION Future areas of development include designing waterless theatre scrubs, waste-trapping technologies for anaesthetic gases and a continuing investment in virtual healthcare.
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Affiliation(s)
- Dimitrios Spinos
- Department of Otorhinolaryngology - Head and Neck Surgery, Gloucestershire Hospitals NHS Foundation Trust, Department of Otolaryngology, Gloucester, UK
| | - Jayesh Doshi
- Department of Otorhinolaryngology - Head and Neck Surgery, Birmingham Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - George Garas
- Head & Neck Surgical Oncology Unit, Department of Otorhinolaryngology - Head and Neck Surgery, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Surgical Innovation Centre, Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, London, UK
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Nordin EJ, Dugan SM, Kusters AC, Schimek CA, Sherman KA, Ebert TJ. How an Audit-and-Feedback-Based Educational Program Contributed to a Reduction in Environmentally Harmful Waste Anesthetic Gases Among Anesthesiology Residents. J Grad Med Educ 2024; 16:175-181. [PMID: 38993317 PMCID: PMC11234298 DOI: 10.4300/jgme-d-23-00402.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 10/15/2023] [Accepted: 02/09/2024] [Indexed: 07/13/2024] Open
Abstract
Background Waste anesthetic gases (WAGs) contribute to greenhouse gas emissions. US anesthesiology resident education on how to reduce WAG-associated emissions is lacking, so we developed an electronic audit-and-feedback-based program to teach residents to reduce fresh gas flow (FGF) and WAG-associated emissions. Objective To assess the program's effectiveness, we measured individual and combined mean FGF of residents during their first, second, and last weeks of the 4-week rotation; then, we calculated the extrapolated annual emissions based on the combined resident mean FGFs. Resident attitudes toward the program were surveyed. Methods During 4-week rotations at a teaching hospital, anesthesia records were scanned to extract resident-assigned cases, FGF, and volatile anesthetic choice during the 2020-2021 academic year. Forty residents across 3 training years received weekly FGF data and extrapolated WAG-associated emissions data via email. Their own FGF data was compared to the low-flow standard FGF of ≤1 liter per minute (LPM) and to the FGF data of their peer residents on rotation with them. An online survey was sent to residents at the end of the project period. Results Between their first and last weeks on rotation, residents decreased their mean FGF by 22% (1.83 vs 1.42 LPM; STD 0.58 vs 0.44; 95% CI 1.67-2.02 vs 1.29-1.56; P<.0001). Ten of 18 (56%) residents who responded to the survey reported their individual case-based results were most motivating toward practice change. Conclusions An audit-and-feedback-based model for anesthesiology resident education, designed to promote climate-conscious practices with administration of volatile anesthetics, was effective.
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Affiliation(s)
- Emily J Nordin
- is a Medical Student, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Shannon M Dugan
- is an Anesthesiology Research Coordinator, Zablocki VA Medical Center, Milwaukee, Wisconsin, USA
| | - Andrew C Kusters
- is a Biomedical Engineer, Zablocki VA Medical Center, Milwaukee, Wisconsin, USA
| | | | - Katherine A Sherman
- is a Statistician, Zablocki VA Medical Center, Milwaukee, Wisconsin, USA; and
| | - Thomas J Ebert
- is a Clinician Scientist, Medical College of Wisconsin, and Zablocki VA Medical Center, Milwaukee, Wisconsin, USA
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Kabanova D, Moret C, Albaladejo P, Slim K. Is a care pathway for enhanced recovery after colorectal surgery environmentally responsible? J Visc Surg 2024; 161:46-53. [PMID: 38114402 DOI: 10.1016/j.jviscsurg.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Above and beyond the environmentally responsible operating theater, the environmental impact of the pathways of surgically treated patients seems essential but has seldom been considered in the literature. On a parallel track, enhanced recovery programmes (ERP) programs are presently deemed a standard of care. The objective of this review is to determine the carbon footprint of the ERP approach in colorectal surgery. METHOD This a narrative review based on articles referenced in PubMed. Our search was centered on the environmental impact of an ERP in the context of colorectal surgery. A number of measures included in the national and international guidelines were studied. We utilized the terms "carbon footprint", "sustainability", "energy cost", "environmental footprint", "life cycle assessment" AND a key word for each subject found in the ERP recommendations. RESULTS Most ERP measures in the context of colorectal surgery are factually or intuitively virtuous from an ecological standpoint. With a 3-day reduction in average hospital stay resulting from ERP, the program permits a reduction of at least 375kg CO2e/patient (Appendices 1 and 2). The most substantial part of this reduction is achieved during the perioperative period. While some measures, such as short fasting, are ecologically neutral, others (treatment of comorbidities, smoking cessation, hypothermia prevention, antibiotic prophylaxis, laparoscopy, absence of drains or probes, thromboprophylaxis, early feeding and mobilization…) lead to fewer postoperative complications, and can consequently be considered as environmentally responsible. Conversely, other measures, one example being robotic surgery, leave a substantial carbon footprint. CONCLUSION ERP is congruent with two pillars of sustainable development: the social pillar (improved patient recovery, and better caregiver working conditions fostered by team spirit), and the economic pillar (decreased healthcare expenses). While the third, environmental pillar is intuitively present, the low number of published studies remains a limitation to be overcome in future qualitative studies.
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Affiliation(s)
| | | | | | - Karem Slim
- Groupe francophone de Réhabilitation Améliorée après Chirurgie (GRACE), allée du Riboulet, 63110 Beaumont, France
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Tee NCH, Yeo JA, Choolani M, Poh KK, Ang TL. Healthcare in the era of climate change and the need for environmental sustainability. Singapore Med J 2024; 65:204-210. [PMID: 38650058 PMCID: PMC11132617 DOI: 10.4103/singaporemedj.smj-2024-035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 04/25/2024]
Abstract
ABSTRACT Climate change is an existential threat to humanity. While the healthcare sector must manage the health-related consequences of climate change, it is a significant contributor to greenhouse gas emissions, responsible for up to 4.6% of global emission, aggravating global warming. Within the hospital environment, the three largest contributors to greenhouse gas emissions are the operating theatre, intensive care unit and gastrointestinal endoscopy. Knowledge of the health-related burden of climate change and the potential transformative health benefits of climate action is important to all health professionals, as they play crucial roles in effecting change. This article summarises the available literature on the impact of healthcare on climate change and efforts in mitigation, focusing on the intrinsic differences and similarities across the operating theatre complex, intensive care unit and gastrointestinal endoscopy unit. It also discusses strategies to reduce carbon footprint.
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Affiliation(s)
- Nicholas Chin Hock Tee
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Jo-Anne Yeo
- Duke-NUS Medical School, Singapore
- Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, Singapore
| | - Mahesh Choolani
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Kian Keong Poh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Hospital, Singapore
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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70
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Reigh EL. Healthcare Pollution Quiz. Ann Allergy Asthma Immunol 2024; 132:455-456. [PMID: 38569756 DOI: 10.1016/j.anai.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 11/06/2023] [Indexed: 04/05/2024]
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Matezak MP, Muret J, Bordenave L, Mazouni-Menard C. Caregiver involvement in an approach favoring sustainable development in the operating theater. J Visc Surg 2024; 161:32-36. [PMID: 38242813 DOI: 10.1016/j.jviscsurg.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
The climate emergency alarm is resounding. Tasked with caregiving, healthcare facilities are nonetheless responsible for apparently innumerable greenhouse gas emissions. Predominantly atmospheric pollution causes 9 million deaths a year throughout the world. While legislative measures have been taken to favor change in climate-related business practices, the effects of their implementation are far from visible. On a parallel track, caregivers have been coming together and calling into question their practices, the objective being to institute concrete actions leading to reduction of healthcare-related carbon footprint. Not all of these actions have the same ecological impact or ease of implementation. To demonstrate their effectiveness and set the stage for readjustments, the existing initiatives require qualitative assessment and quantitative appraisal. While they demand personal motivation and professional investment, these efforts have a triple impact, at once ecological, economic and related to quality of life. Multidisciplinary teams come together in the pursuit of a common project epitomizing our missions as caregivers; is not that the essence of our presence in hospital?
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Affiliation(s)
- Marie-Pierre Matezak
- AP-HP, Center for Training and Skills Development, Bicêtre Hospital, Paris, France.
| | - Jane Muret
- Anesthesia-Resuscitation-Pain-Infectiology Department, Curie Institute, Paris, France
| | - Lauriane Bordenave
- Anesthesia-Resuscitation Department, Cancer Campus Gustave-Roussy, Villejuif, France
| | - Chafika Mazouni-Menard
- Quality-Risk Management Department Sustainable Development, Eure Seine Hospital Center, France
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Maestri F, Ferrero A, Rothschild PR, Eymard P, Brézin AP, Monnet D. The carbon footprint and wastage of intravitreal injections. J Fr Ophtalmol 2024; 47:104079. [PMID: 38377875 DOI: 10.1016/j.jfo.2024.104079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/23/2023] [Accepted: 08/31/2023] [Indexed: 02/22/2024]
Abstract
PURPOSE The healthcare system emits greenhouse gas emissions and produces waste that in turn threatens the health of populations. The objective of our study was to measure the ecological threat related to intravitreal injections. METHODS Emissions were separated into scope 2 corresponding to Heating, Ventilation and Air Conditioning (HVAC) of the building, and scope 3 corresponding to travels (patients and staff), and life cycle assessment (LCA) of medical devices (MD) and pharmaceutics. Greenhouse gas (GHG) emissions and waste for a single injection were first measured through a waste audit, and secondly anticipated theoretically with a calculator. RESULTS The average GHG emissions and waste measured were 277kgCO2eq/IVI and 0.5kg/IVI, respectively. Pharmaceuticals were responsible for 97% of total emissions. Emissions unrelated to pharmaceuticals counted for 8.4kgCO2eq/IVI. GHG emissions and waste estimated with the calculator were 276kgCO2eq/IVI and 0.5kg/IVI, respectively, showing that the calculator was accurate. CONCLUSION Our study provides a puzzle piece to carbon footprint and waste assessment in the field of ophthalmology. It may help provide concrete data for future green vs. vision discussions.
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Affiliation(s)
- F Maestri
- Service d'ophtalmologie, hôpital Cochin, Paris, France.
| | - A Ferrero
- Service d'ophtalmologie, hôpital Cochin, Paris, France
| | | | - P Eymard
- Service d'ophtalmologie, hôpital Cochin, Paris, France
| | - A P Brézin
- Service d'ophtalmologie, hôpital Cochin, Paris, France
| | - D Monnet
- Service d'ophtalmologie, hôpital Cochin, Paris, France
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de'Angelis N, Conso C, Bianchi G, Rodríguez AGB, Marchegiani F, Carra MC, Lafont C, Canouï-Poitrine F, Slim K, Pessaux P. Systematic review of carbon footprint of surgical procedures. J Visc Surg 2024; 161:7-14. [PMID: 38087700 DOI: 10.1016/j.jviscsurg.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
The ecological sustainability of the operating room (OR) is a matter of recent interest. The present systematic review aimed to review the current literature assessing the carbon footprint of surgical procedures in different surgical fields. Following to the PRISMA statement checklist, three databases (MEDLINE, EMBASE, Cochrane Library) were searched by independent reviewers, who screened records on title and abstract first, and then on the full text. Risk of bias was evaluated using the MINORS system. Over the 878 articles initially identified, 36 original studies were included. They considered ophthalmologic surgical procedures (30.5%), general/digestive surgery (19.4%), gynecologic procedures (13.9%), orthopedic procedures (8.3%), neurosurgery (5.5%), otolaryngology/head and neck surgery (5.5%), plastic/dermatological surgery (5.5%), and cardiac surgery (2.8%). Despite a great methodological heterogeneity, data showed that a single surgical procedure emits 4-814 kgCO2e, with anesthetic gases and energy consumption representing the largest sources of greenhouse gas emission. Minimally invasive surgical techniques may require more resources than conventional open surgery, particularly for packaging and plastics, energy use, and waste production. Each OR has the potential to produce from 0.2 to 4kg of waste per case with substantial differences depending on the type of intervention, hospital setting, and geographic area. Overall, the selected studies were found to be of moderate quality. Based on a qualitative synthesis of the available literature, the OR can be targeted by programs and protocols implemented to reduce the carbon footprint and improve the waste stream of the OR.
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Affiliation(s)
- Nicola de'Angelis
- DIGEST department, unit of colorectal and digestive surgery, faculty of medicine, Beaujon university hospital, university of Paris Cité, AP-HP, Paris, France
| | - Christel Conso
- Service de chirurgie orthopedique, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - Giorgio Bianchi
- DIGEST department, unit of colorectal and digestive surgery, faculty of medicine, Beaujon university hospital, university of Paris Cité, AP-HP, Paris, France
| | - Ana Gabriela Barría Rodríguez
- DIGEST department, unit of colorectal and digestive surgery, faculty of medicine, Beaujon university hospital, university of Paris Cité, AP-HP, Paris, France
| | - Francesco Marchegiani
- DIGEST department, unit of colorectal and digestive surgery, faculty of medicine, Beaujon university hospital, university of Paris Cité, AP-HP, Paris, France
| | - Maria Clotilde Carra
- Service of odontology, department of periodontology, Rothschild hospital, U.F.R. of odontology-Garancière, université de Paris, AP-HP, 75006 Paris, France
| | - Charlotte Lafont
- Service de santé publique, hôpital Henri-Mondor, 94010 Créteil cedex, France; IMRB, Inserm U955, équipe Clinical Epidemiology And Ageing (CEpiA), université Paris Est Créteil (UPEC), France
| | - Florence Canouï-Poitrine
- Service de santé publique, hôpital Henri-Mondor, 94010 Créteil cedex, France; IMRB, Inserm U955, équipe Clinical Epidemiology And Ageing (CEpiA), université Paris Est Créteil (UPEC), France
| | - Karem Slim
- Department of digestive surgery, Francophone Group for Enhanced Recovery After Surgery (GRACE), university hospital, CHU Clermont-Ferrand, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - Patrick Pessaux
- Digestive surgery department, HPB unit, Nouvel Hôpital Civil, university of Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
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Drinhaus H, Drinhaus J, Schumacher C, Schramm MJ, Wetsch WA. Electricity consumption of anesthesia workstations and potential emission savings by avoiding standby. DIE ANAESTHESIOLOGIE 2024; 73:244-250. [PMID: 38349537 PMCID: PMC11021308 DOI: 10.1007/s00101-024-01388-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/25/2024] [Accepted: 01/30/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Anesthesiology has a relevant carbon footprint, mainly due to volatile anesthetics (scope 1 emissions). Additionally, energy used in the operating theater (scope 2 emissions) contributes to anesthesia-related greenhouse gas (GHG) emissions. OBJECTIVES Optimizing the electricity use of medical devices might reduce both GHG emissions and costs might hold potential to reduce anaesthesia-related GHG-emissions and costs. We analyzed the electricity consumption of six different anesthesia workstations, calculated their GHG emissions and electricity costs and investigated the potential to reduce emissions and cost by using the devices in a more efficient way. METHODS Power consumption (active power in watt , W) was measured with the devices off, in standby mode, or fully on with the measuring instrument SecuLife ST. Devices studied were: Dräger Primus, Löwenstein Medical LeonPlus, Getinge Flow C, Getinge Flow E, GE Carestation 750 and GE Aisys. Calculations of GHG emissions were made with different emission factors, ranging from very low (0.09 kg CO2-equivalent/kWh) to very high (0.660 kg CO2-equivalent/kWh). Calculations of electricity cost were made assuming a price of 0.25 € per kWh. RESULTS Power consumption during operation varied from 58 W (GE CareStation 750) to 136 W (Dräger Primus). In standby, the devices consumed between 88% and 93% of the electricity needed during use. The annual electricity consumption to run 96 devices in a large clinical department ranges between 45 and 105 Megawatt-hours (MWh) when the devices are left in standby during off hours. If 80% of the devices are switched off during off hours, between 20 and 46 MWh can be saved per year in a single institution. At the average emission factor of our hospital, this electricity saving corresponds to a reduction of GHG emissions between 8.5 and 19.8 tons CO2-equivalent. At the assumed prices, a cost reduction between 5000 € and 11,600 € could be achieved by this intervention. CONCLUSION The power consumption varies considerably between the different types of anesthesia workstations. All devices exhibit a high electricity consumption in standby mode. Avoiding standby mode during off hours can save energy and thus GHG emissions and cost. The reductions in GHG emissions and electricity cost that can be achieved with this intervention in a large anesthesiology department are modest. Compared with GHG emissions generated by volatile anesthetics, particularly desflurane, optimization of electricity consumption of anesthesia workstations holds a much smaller potential to reduce the carbon footprint of anesthesia; however, as switching off anesthesia workstations overnight is relatively effortless, this behavioral change should be encouraged from both an ecological and economical point of view.
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Affiliation(s)
- Hendrik Drinhaus
- Faculty of Medicine and University Hospital of Cologne, Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | | | - Christine Schumacher
- Faculty of Medicine and University Hospital of Cologne, Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Michael J Schramm
- Faculty of Medicine and University Hospital of Cologne, Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | - Wolfgang A Wetsch
- Faculty of Medicine and University Hospital of Cologne, Department of Anesthesiology and Intensive Care Medicine, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Slim K, Villet R. Glossary of sustainable development for the ecofriendly surgeon. J Visc Surg 2024; 161:3-6. [PMID: 38216345 DOI: 10.1016/j.jviscsurg.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2024]
Affiliation(s)
- Karem Slim
- Department of Digestive Surgery, CHU de Clermont-Ferrand, Clermont-Ferrand, France; Collectif d'eco-responsabilité en santé (CERES), Paris, France.
| | - Richard Villet
- Académies nationales de médecine et de chirurgie, Paris, France
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Cohen ES, Kouwenberg LHJA, Moody KS, Sperna Weiland NH, Kringos DS, Timmermans A, Hehenkamp WJK. Environmental sustainability in obstetrics and gynaecology: A systematic review. BJOG 2024; 131:555-567. [PMID: 37604701 DOI: 10.1111/1471-0528.17637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 07/04/2023] [Accepted: 07/29/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND The healthcare sector is responsible for 4%-10% of global greenhouse gas emissions. Considering the broad range of care that obstetricians and gynaecologists provide, mitigation strategies within this specialty could result in significant reductions of the environmental footprint across the whole healthcare industry. OBJECTIVES The aim of this review was to identify for what services, procedures and products within obstetric and gynaecological care the environmental impact has been studied, to assess the magnitude of such impact and to identify mitigation strategies to diminish it. SEARCH STRATEGY The search strategy combined terms related to environmental impact, sustainability, climate change or carbon footprint, with the field of obstetrics and gynaecology. SELECTION CRITERIA Articles reporting on the environmental impact of any service, procedure or product within the field of obstetrics and gynaecology were included. Included outcomes covered midpoint impact categories, CO2 emissions, waste generation and energy consumption. DATA COLLECTION AND ANALYSIS A systematic literature search was conducted in the databases of MEDLINE (Ovid), Embase (Ovid) and Scopus, and a grey literature search was performed on Google Scholar and two websites of gynaecological associations. MAIN RESULTS The scope of the investigated studies encompassed vaginal births, obstetric and gynaecological surgical procedures, menstrual products, vaginal specula and transportation to gynaecological oncologic consultations. Among the highest yielding mitigation strategies were displacing disposable with reusable materials and minimising content of surgical custom packs. The lowest yielding mitigation strategy was waste optimisation, including recycling. CONCLUSIONS This systematic review highlights opportunities for obstetricians and gynaecologists to decrease their environmental footprint in many ways. More high-quality studies are needed to investigate the environmental impact of other aspects of women's and reproductive health care.
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Affiliation(s)
- Eva Sayone Cohen
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Quality of Care, Global Health, Amsterdam Public Health, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Lisanne H J A Kouwenberg
- Quality of Care, Global Health, Amsterdam Public Health, Amsterdam, The Netherlands
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Kate S Moody
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Nicolaas H Sperna Weiland
- Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Anaesthesiology, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Dionne Sofia Kringos
- Quality of Care, Global Health, Amsterdam Public Health, Amsterdam, The Netherlands
- Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
| | - Anne Timmermans
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - Wouter J K Hehenkamp
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Chauvet P, Enguix A, Sautou V, Slim K. A systematic review comparing the safety, cost and carbon footprint of disposable and reusable laparoscopic devices. J Visc Surg 2024; 161:25-31. [PMID: 38272757 DOI: 10.1016/j.jviscsurg.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
INTRODUCTION The objective of this systematic review of the literature is to compare a selection of currently utilized disposable and reusable laparoscopic medical devices in terms of safety (1st criteria), cost and carbon footprint. MATERIAL AND METHODS A search was carried out on electronic databases for articles published up until 6 May 2022. The eligible works were prospective (randomized or not) or retrospective clinical or medical-economic comparative studies having compared disposable scissors, trocars, and mechanical endoscopic staplers to the same instruments in reusable. Two different independent examiners extracted the relevant data. RESULTS Among the 2882 articles found, 156 abstracts were retained for examination. After comprehensive analysis concerning the safety and effectiveness of the instruments, we included four articles. A study on trocars highlighted increased vascular complications with disposable instruments, and another study found more perioperative incidents with a hybrid stapler as opposed to a disposable stapler. As regards cost analysis, we included 11 studies, all of which showed significantly higher costs with disposable instruments. The results of the one study on carbon footprints showed that hybrid instruments leave four times less of a carbon footprint than disposable instruments. CONCLUSION The literature on the theme remains extremely limited. Our review demonstrated that from a medical and economic standpoint, reusable medical instruments, particularly trocars, presented appreciable advantages. While there exist few data on the ecological impact, those that do exist are unmistakably favorable to reusable instruments.
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Affiliation(s)
- Pauline Chauvet
- Gynecology and Obstetrics Department, CHU de Clermont-Ferrand, 63003 Clermont-Ferrand, France.
| | - Audrey Enguix
- Pharmacy Department, CHU de Clermont-Ferrand, Clermont-Ferrand, France
| | - Valérie Sautou
- Clermont Auvergne University, CHU de Clermont Ferrand, Clermont Auvergne INP, CNRS, ICCF, 63000 Clermont-Ferrand, France
| | - Karem Slim
- Digestive Surgery Department CHU de Clermont-Ferrand, Clermont-Ferrand, France; Collectif d'Eco-Responsabilité En Santé, Beaumont, France
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Akinocho EM, Ashraf M, Badirou N, Philippe HJ. Knowledge of surgeons and practical stances of healthcare institutions in the Ile-de-France region toward sustainable development: A cross-sectional study. J Visc Surg 2024; 161:15-20. [PMID: 36653287 DOI: 10.1016/j.jviscsurg.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE OF THE STUDY Climate change represents one of the gravest threats to health. Surgical activities mobilize a large number of resources which contribute to increased emission of CO2 and anesthetic gases in the environment. The objective of this study was to assess the level of knowledge of surgeons and the practical stances of healthcare establishments toward sustainable development. METHODS This was a descriptive cross-sectional study, lasting 2 months. From 1 May 2021 to 30 June 2021, surgeons were asked via an online questionnaire to participate. RESULTS A total of 131 out of the 457 contacted surgeons responded. A majority practiced in the private sector, 48.9% knew little about the rules of sustainable development in operating theaters, and 43.5% had an average level. The sustainable development charter was available in only 23% of establishments, while 19% had a sustainable development committee, and specific sustainable development actions were carried out in 27%. CONCLUSION The level of knowledge of surgeons in Île-de-France on sustainable development was low. In general, surgical units were not complying with the rules of good practice on CO2 reduction. It is necessary to find strategies to reduce the impact of operating theaters on the environment.
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Affiliation(s)
- E-M Akinocho
- Sud Francilien Hospital Center, Corbeil-Essonnes Cedex, France; Regional Observatory for Day Surgery, Île-de-France Regional Health Agency, Paris, France.
| | - M Ashraf
- Sud Francilien Hospital Center, Corbeil-Essonnes Cedex, France; Regional Observatory for Day Surgery, Île-de-France Regional Health Agency, Paris, France
| | - N Badirou
- Sud Francilien Hospital Center, Corbeil-Essonnes Cedex, France; Regional Observatory for Day Surgery, Île-de-France Regional Health Agency, Paris, France
| | - H-J Philippe
- Regional Observatory for Day Surgery, Île-de-France Regional Health Agency, Paris, France; AP-HP Paris-centre, Paris cité University, Paris, France
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Spil NA, van Nieuwenhuizen KE, Rowe R, Thornton JG, Murphy E, Verheijen E, Shelton CL, Heazell AEP. The carbon footprint of different modes of birth in the UK and the Netherlands: An exploratory study using life cycle assessment. BJOG 2024; 131:568-578. [PMID: 38272843 DOI: 10.1111/1471-0528.17771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 01/02/2024] [Accepted: 01/10/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVE To compare the carbon footprint of caesarean and vaginal birth. DESIGN Life cycle assessment (LCA). SETTING Tertiary maternity units and home births in the UK and the Netherlands. POPULATION Birthing women. METHODS A cradle-to-grave LCA using openLCA software to model the carbon footprint of different modes of delivery in the UK and the Netherlands. MAIN OUTCOME MEASURES 'Carbon footprint' (in kgCO2 equivalents [kgCO2 e]). RESULTS Excluding analgesia, the carbon footprint of a caesarean birth in the UK was 31.21 kgCO2 e, compared with 12.47 kgCO2 e for vaginal birth in hospital and 7.63 kgCO2 e at home. In the Netherlands the carbon footprint of a caesarean was higher (32.96 kgCO2 e), but lower for vaginal birth in hospital and home (10.74 and 6.27 kgCO2 e, respectively). Emissions associated with analgesia for vaginal birth ranged from 0.08 kgCO2 e (with opioid analgesia) to 237.33 kgCO2 e (nitrous oxide with oxygen). Differences in analgesia use resulted in a lower average carbon footprint for vaginal birth in the Netherlands than the UK (11.64 versus 193.26 kgCO2 e). CONCLUSION The carbon footprint of a caesarean is higher than for a vaginal birth if analgesia is excluded, but this is very sensitive to the analgesia used; use of nitrous oxide with oxygen multiplies the carbon footprint of vaginal birth 25-fold. Alternative methods of pain relief or nitrous oxide destruction systems would lead to a substantial improvement in carbon footprint. Although clinical need and maternal choice are paramount, protocols should consider the environmental impact of different choices.
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Affiliation(s)
- Nienke A Spil
- Division of Developmental Biology and Medicine, Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- University of Groningen, Groningen, The Netherlands
| | | | - Rachel Rowe
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Elizabeth Murphy
- Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Evelyn Verheijen
- Department of Gynaecology, Saxenburgh Medisch Centrum, Hardenberg, The Netherlands
| | - Clifford L Shelton
- Department of Anaesthesia, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | - Alexander E P Heazell
- Division of Developmental Biology and Medicine, Maternal and Fetal Health Research Centre, School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- Saint Mary's Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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Rouvière N, Pitard M, Boutry E, Prudhomme M, Bertrand M, Leguelinel-Blache G, Chasseigne V. How a hospital pharmacist can contribute to a more sustainable operating theater. J Visc Surg 2024; 161:37-45. [PMID: 38092591 DOI: 10.1016/j.jviscsurg.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Healthcare sectors, particularly operating theaters, are major consumers of resources. Given today's climate-related issues, its seems vital that the different healthcare professionals in operating areas become aware of their roles. This is pronouncedly the case for hospital pharmacists, who fulfill cross-sectional functions in the proper use and management of healthcare products and sterile medical devices. The objective of this review of the literature is to identify the actions a hospital pharmacist can take to impel evolution toward ecologically responsible care in the operating theater. Seven areas in which a pharmacist can assume a leading, supporting or composite role in rendering an operating theater ecologically responsible have been highlighted: purchasing, procurement and storage, harmonization of practices, modification of practices, professional attire, waste elimination and research/teaching. The active participation of all healthcare professionals, including the hospital pharmacist, is essential to the development of a sustainable approach to healthcare.
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Affiliation(s)
- Ninon Rouvière
- Pharmacy department, Nîmes University Hospital Center, Montpellier University, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France
| | - Maria Pitard
- Pharmacy department, Nîmes University Hospital Center, Montpellier University, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France
| | - Etienne Boutry
- Digestive Surgery Department, Nîmes University Hospital Center, University of Montpellier, Nîmes, France
| | - Michel Prudhomme
- Digestive Surgery Department, Nîmes University Hospital Center, University of Montpellier, Nîmes, France
| | - Martin Bertrand
- Digestive Surgery Department, Nîmes University Hospital Center, University of Montpellier, Nîmes, France
| | - Géraldine Leguelinel-Blache
- Pharmacy department, Nîmes University Hospital Center, Montpellier University, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France; Desbrest Institute of Epidemiology and Public Health, Inserm, University of Montpellier, Montpellier, France
| | - Virginie Chasseigne
- Pharmacy department, Nîmes University Hospital Center, Montpellier University, place du Professeur-Robert-Debré, 30029 Nîmes cedex 9, France; Desbrest Institute of Epidemiology and Public Health, Inserm, University of Montpellier, Montpellier, France.
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81
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Slim K, Martin F. Surgery, innovation, research and sustainable development. J Visc Surg 2024; 161:63-68. [PMID: 38071141 DOI: 10.1016/j.jviscsurg.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
In the healthcare sector, surgery (especially in the operating theatre) is responsible for emission of greenhouse gases, which is a source of global warming. The goal of this largely quantitative assessment is to address three questions on carbon footprint associated with surgery, the role of primary and secondary prevention prior to surgical procedures, and incorporation of the carbon footprint into judgment criteria in research and surgical innovations. It appears that while the impact of surgery on global warming is undeniable, its extent depends on means of treatment and geographical location. Before and after an operation, primary, secondary and tertiary prevention accompanied by surgical sobriety (avoiding unnecessary or unjustified actions) can be virtuous in terms of sustainable development. However, the sanitary benefits of these actions are often opposed to environmental benefit, which has yet to be satisfactorily assessed. Lastly, the carbon footprint has yet to be incorporated into research protocols or the innovations under development. This should impel us not only to sensitize the different healthcare actors to relevant issues, but also to improve working conditions.
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Affiliation(s)
- Karem Slim
- Digestive Surgery Department, CHU Clermont-Ferrand, Clermont-Ferrand, France; Collectif d'Eco-Responsabilité En Santé (CERES), Beaumont, France.
| | - Frédéric Martin
- Private Hospitals of Versailles - Ramsay Santé, Versailles, France
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82
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Paasch C, Meyer J, Hunger R, Krollmann N, Heisler S, Mantke R. Does the angle of trocar insertion affect the fascial defect caused? A porcine model. Hernia 2024; 28:585-592. [PMID: 38319439 PMCID: PMC10997682 DOI: 10.1007/s10029-023-02952-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 12/07/2023] [Indexed: 02/07/2024]
Abstract
INTRODUCTION With an incidence of 0-5.2%, trocar site hernias frequently occur following laparoscopy. It is unclear to what extent the angle of trocar insertion affects the size of the fascial defect caused. Hence, we performed a porcine model. METHODS In October 2022, a total of five female pigs were euthanized. In alternating order, three bladeless and two bladed conical 12-mm trocars were inserted at an angle of 45° on each side for 60 min twice each pig. For this purpose, an epoxy resin handmade cuboid with a central channel that runs at an angle of 45° was used. Subsequently, photo imaging and defect size measurement took place. The results were compared with those of our previously conducted and published porcine model, in which the trocars were inserted at an angle of 90°. Effects of trocar type (bladed vs. bladeless) and angle on defect size were analyzed using a mixed model regression analysis. RESULTS The bladeless trocars caused statistically significant smaller defects at the fascia than the bladed (23.4 (SD = 16.9) mm2 vs. 41.3 (SD = 14.8) mm2, p < 0.001). The bladeless VersaOne trocar caused the smallest defect of 16.0 (SD = 6.1) mm2. The bladed VersaOne trocar caused the largest defect of 47.7 (SD = 10.5) mm2. The defect size of the trocars used at a 45° angle averaged 30.5 (SD = 18.3) mm2. The defect size of trocars used at a 90° angle was significantly larger, averaging 58.3 (SD = 20.2) mm2 (p = 0.007). CONCLUSION When conical 12-mm trocars are inserted at a 45° angle, especially bladeless ones, they appear to cause small fascial defects compared with insertion at a 90° angle. This might lead also to a lower rate of trocar hernias. Bladeless trocars might cause smaller fascial defects than bladed trocars.
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Affiliation(s)
- C Paasch
- Department of General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Clinic for General and Visceral Surgery, Hochstraße 29, 14770, Brandenburg, Germany.
| | - J Meyer
- Department of General and Visceral Surgery, Ameos Hospital Schönebeck, Schönebeck, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - R Hunger
- Faculty of Medicine, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
| | - N Krollmann
- Department of General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Clinic for General and Visceral Surgery, Hochstraße 29, 14770, Brandenburg, Germany
| | - S Heisler
- Department of General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Clinic for General and Visceral Surgery, Hochstraße 29, 14770, Brandenburg, Germany
| | - R Mantke
- Department of General and Visceral Surgery, University Hospital Brandenburg an der Havel, Brandenburg Medical University, Clinic for General and Visceral Surgery, Hochstraße 29, 14770, Brandenburg, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
- Faculty of Medicine, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany
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Gonzalez-Pizarro P, Brazzi L, Koch S, Trinks A, Muret J, Sperna Weiland N, Jovanovic G, Cortegiani A, Fernandes TD, Kranke P, Malisiova A, McConnell P, Misquita L, Romero CS, Bilotta F, De Robertis E, Buhre W. European Society of Anaesthesiology and Intensive Care consensus document on sustainability: 4 scopes to achieve a more sustainable practice. Eur J Anaesthesiol 2024; 41:260-277. [PMID: 38235604 DOI: 10.1097/eja.0000000000001942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Climate change is a defining issue for our generation. The carbon footprint of clinical practice accounts for 4.7% of European greenhouse gas emissions, with the European Union ranking as the third largest contributor to the global healthcare industry's carbon footprint, after the United States and China. Recognising the importance of urgent action, the European Society of Anaesthesiology and Intensive Care (ESAIC) adopted the Glasgow Declaration on Environmental Sustainability in June 2023. Building on this initiative, the ESAIC Sustainability Committee now presents a consensus document in perioperative sustainability. Acknowledging wider dimensions of sustainability, beyond the environmental one, the document recognizes healthcare professionals as cornerstones for sustainable care, and puts forward recommendations in four main areas: direct emissions, energy, supply chain and waste management, and psychological and self-care of healthcare professionals. Given the urgent need to cut global carbon emissions, and the scarcity of evidence-based literature on perioperative sustainability, our methodology is based on expert opinion recommendations. A total of 90 recommendations were drafted by 13 sustainability experts in anaesthesia in March 2023, then validated by 36 experts from 24 different countries in a two-step Delphi validation process in May and June 2023. To accommodate different possibilities for action in high- versus middle-income countries, an 80% agreement threshold was set to ease implementation of the recommendations Europe-wide. All recommendations surpassed the 80% agreement threshold in the first Delphi round, and 88 recommendations achieved an agreement >90% in the second round. Recommendations include the use of very low fresh gas flow, choice of anaesthetic drug, energy and water preserving measures, "5R" policies including choice of plastics and their disposal, and recommendations to keep a healthy work environment or on the importance of fatigue in clinical practice. Executive summaries of recommendations in areas 1, 2 and 3 are available as cognitive aids that can be made available for quick reference in the operating room.
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Affiliation(s)
- Patricio Gonzalez-Pizarro
- From the Department of Paediatric Anaesthesia and Critical Care. La Paz University Hospital, Madrid, Spain (PGP), the Department of Anaesthesia, Intensive Care and Emergency, 'Citta' della Salute e della Scienza' University Hospital, Department of Surgical Science, University of Turin, Turin, Italy (LB), the University of Southern Denmark (SDU) Odense, Department of Anesthesia, Hospital of Nykobing Falster, Denmark (SK), the Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt Universität zu Berlin, Campus Charité Mitte, and Campus Virchow Klinikum (SK), the Department of Anaesthesiology. LMU University Hospital, LMU Munich, Germany (AT), the Department of Anaesthesia and Intensive Care. Institute Curie & PSL Research University, Paris, France (JM), the Department of Anaesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands (NSW), the Department of Anaesthesia and Perioperatve Medicine. Medical Faculty, University of Novi Sad, Novi Sad, Serbia (GJ), the Department of Surgical, Oncological and Oral Science, University of Palermo, Italy. Department of Anesthesia, Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, Palermo, Italy (AC), the Department of Anaesthesiology, Hospital Pedro Hispano, Matosinhos, Portugal (TDF), the Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Germany (PK), the Department of Anaesthesiology and Pain. P&A Kyriakou Children's Hospital Athens Greece (AM), Royal Alexandra Hospital. Paisley, Scotland, United Kingdom (PM), Department of Neuro-anaesthesia and Neurocritical Care, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, England, United Kingdom (LM), the Department of Anesthesia, Critical care and Pain Unit, Hospital General Universitario de Valencia. Research Methods Department, European University of Valencia, Spain (CR), the "Sapienza" University of Rome, Department of Anesthesiology and Critical Care, Rome, Italy (FB), the Division of Anaesthesia, Analgesia, and Intensive Care - Department of Medicine and Surgery - University of Perugia Ospedale S. Maria della Misericordia, Perugia, Italy (EDR), the Division of Anaesthesiology, Intensive Care and Emergency Medicine, Department of Anaesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands (WB)
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84
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Kampman JM, Plasmans KYQ, Hermanides J, Hollmann MW, Repping S, Sperna Weiland NH. Influence of nitrous oxide added to general anaesthesia on postoperative mortality and morbidity: a systematic review and meta-analysis. Br J Anaesth 2024:S0007-0912(24)00073-4. [PMID: 38471989 DOI: 10.1016/j.bja.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Nitrous oxide (N2O) is a common adjuvant to general anaesthesia. It is also a potent greenhouse gas and causes ozone depletion. We sought to quantify the influence of N2O as an adjuvant to general anaesthesia on postoperative patient outcomes. METHODS We searched Medline, EMBASE, and Cochrane Central for works published from inception to July 6, 2023. RCTs comparing general anaesthesia with or without N2O were included. Risk ratios (RRs) and standardised mean differences (SMDs) were calculated, along with 95% confidence intervals (CIs), using a random-effects model. Outcomes were derived from the Standardised Endpoints for Perioperative Medicine (StEP) outcome set. Primary outcomes were mortality and organ-related morbidity, and secondary outcomes were anaesthetic and surgical morbidity. RESULTS Of 3305 records, 179 full-text articles were assessed, and 71 RCTs, totalling 22 147 patients, were included in the meta-analysis. Addition of N2O to general anaesthesia did not influence postoperative mortality or most morbidity outcomes. N2O increased the incidence of atelectasis (RR 1.62, 95% CI 1.24 to 2.12) and postoperative nausea and vomiting (RR 1.27, 95% CI 1.15 to 1.40), and decreased intraoperative opioid consumption (SMD -0.19, 95% CI -0.35 to -0.04) and time to extubation (MD -2.17 min, 95% CI -3.32 to -1.03 min). CONCLUSIONS N2O did not influence postoperative mortality or most morbidity outcomes. Considering the environmental effects of N2O, these findings confirm that current policy recommendations to limit its use do not affect patient safety. SYSTEMATIC REVIEW PROTOCOL PROSPERO CRD42023443287.
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Affiliation(s)
- Jasper M Kampman
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam UMC Centre for Sustainable Healthcare, Amsterdam UMC, Amsterdam, The Netherlands.
| | - Kim Y Q Plasmans
- Department of Anaesthesiology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - Jeroen Hermanides
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Markus W Hollmann
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Sjoerd Repping
- Healthcare Evaluation and Appropriate Use, National Healthcare Institute, Diemen, The Netherlands; Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicolaas H Sperna Weiland
- Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam UMC Centre for Sustainable Healthcare, Amsterdam UMC, Amsterdam, The Netherlands
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85
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Al-Kindi S, Brook RD, Rajagopalan S. Green cardiovascular care: a call for sustainable transformation of cardiovascular practices. Eur Heart J 2024; 45:744-747. [PMID: 38190318 DOI: 10.1093/eurheartj/ehad844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2024] Open
Affiliation(s)
- Sadeer Al-Kindi
- Department of Cardiology, DeBakey Heart and Vascular Center, Houston Methodist Hospital, 6550 Fannin Street, Houston, TX 77030, USA
| | - Robert D Brook
- Cardiovascular Disease Prevention, Wayne Health and Wayne State University, Detroit, MI, USA
| | - Sanjay Rajagopalan
- Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH 44106, USA
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86
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Huang Z, Zhai J, Li Z, Yu L. Populus euphratica has stronger regrowth ability than Populus pruinosa under salinity stress. PHYSIOLOGIA PLANTARUM 2024; 176:e14297. [PMID: 38634382 DOI: 10.1111/ppl.14297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/18/2024] [Accepted: 03/22/2024] [Indexed: 04/19/2024]
Abstract
Pest infestation and soil salinization levels are increasing due to climate change. Comprehending plant regrowth after insect damage and salinity stress is crucial to understanding climate change's multifactorial impacts on forest ecosystems. This study examined Populus euphratica and P. pruinosa regrowth after different defoliation levels combined with salinity stress. Specifically, the biomass and regrowth ability, non-structural carbohydrate (NSC) and nitrogen (N) pools in different organs and the whole plant, and the leaf Cl- concentration of both poplars were analyzed. Our results showed that after 50% defoliation and no salt addition, the regrowth of both species recovered similarly to the control level, while their regrowth was about 70% after 90% defoliation. However, under salinity stress, the regrowth (% leaf biomass) of P. euphratica was significantly higher than P. pruinose at either the 50% or 90% defoliation levels. Additionally, P. euphratica had more soluble sugar, starch, NSC and N pools in leaf, stem, root and whole plant than P. pruinose under salinity stress. The regrowth based on leaf biomass increased linearly with soluble sugar, starch, NSC and N pools, and decreased linearly with leaf Cl- concentration across different salinity and defoliation levels. These results indicated that defoliation significantly decreased NSC and N pools, limiting the growth of both poplars, and salinity stress exacerbated the negative effect. Furthermore, when suffering from salinity stress, P. euphratica with higher NSC and N pools exhibited stronger regrowth ability than P. pruinose.
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Affiliation(s)
- Zongdi Huang
- Department of Ecology, College of Life and Environmental Sciences, Hangzhou Normal University, Hangzhou, China
| | - Juntuan Zhai
- College of Life Science and Technology, Tarim University, China
| | - Zhijun Li
- College of Life Science and Technology, Tarim University, China
| | - Lei Yu
- Department of Ecology, College of Life and Environmental Sciences, Hangzhou Normal University, Hangzhou, China
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87
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Bernat M, Boyer A, Roche M, Richard C, Bouvet L, Remacle A, Antonini F, Poirier M, Pastene B, Hammad E, Fond G, Bruder N, Leone M, Zieleskiewicz L. Reducing the carbon footprint of general anaesthesia: a comparison of total intravenous anaesthesia vs. a mixed anaesthetic strategy in 47,157 adult patients. Anaesthesia 2024; 79:309-317. [PMID: 38205529 DOI: 10.1111/anae.16221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2023] [Indexed: 01/12/2024]
Abstract
Global warming is a major public health concern. Volatile anaesthetics are greenhouse gases that increase the carbon footprint of healthcare. Modelling studies indicate that total intravenous anaesthesia is less carbon intensive than volatile anaesthesia, with equivalent quality of care. In this observational study, we aimed to apply the findings of previous modelling studies to compare the carbon footprint per general anaesthetic of an exclusive TIVA strategy vs. a mixed TIVA-volatile strategy. This comparative retrospective study was conducted over 2 years in two French hospitals, one using total intravenous anaesthesia only and one using a mixed strategy including both intravenous and inhalation anaesthetic techniques. Based on pharmacy procurement records, the quantity of anaesthetic sedative drugs was converted to carbon dioxide equivalents. The primary outcome was the difference in carbon footprint of hypnotic drugs per intervention between the two strategies. From 1 January 2021 to 31 December 2022, 25,137 patients received general anaesthesia in the hospital using the total intravenous anaesthesia strategy and 22,020 in the hospital using the mixed strategy. The carbon dioxide equivalent footprint of hypnotic drugs per intervention in the hospital using the total intravenous anaesthesia strategy was 20 times lower than in the hospital using the mixed strategy (emissions of 2.42 kg vs. 48.85 kg carbon dioxide equivalent per intervention, respectively). The total intravenous anaesthesia strategy significantly reduces the carbon footprint of hypnotic drugs in general anaesthesia in adult patients compared with a mixed strategy. Further research is warranted to assess the risk-benefit ratio of the widespread adoption of total intravenous anaesthesia.
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Affiliation(s)
- M Bernat
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - A Boyer
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - M Roche
- Pharmacy Department, Service Central des Opérations Pharmaceutiques, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - C Richard
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - L Bouvet
- Department of Anesthesia and Critical Care, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - A Remacle
- Departement of Medical Information, Hôpital Nord, Marseille, France
| | - F Antonini
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - M Poirier
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - B Pastene
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - E Hammad
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - G Fond
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - N Bruder
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - M Leone
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - L Zieleskiewicz
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
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88
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Dölker T, Schuler J, Wallqvist J, Rossaint R, Kowark A, Ziemann S, Schneider F, Baumann AA, Conway N, Grüßer L. Easy-to-implement educational interventions to bring climate-smart actions to daily anesthesiologic practice: a cross-sectional before and after study. Minerva Anestesiol 2024; 90:126-134. [PMID: 38535970 DOI: 10.23736/s0375-9393.23.17767-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
BACKGROUND Anesthesia contributes significantly to a hospital's carbon footprint. Climate-smart actions have the potential to reduce greenhouse gas emissions. Prerequisites for sustainable behavior of providers are knowledge and awareness. We aimed to assess the change in anesthesiologists' climate-friendly behavior before and after educational interventions in three areas that every anesthesiologist can address in their daily clinical routine: 1) energy use; 2) recycling opportunities; 3) consumption of volatile anesthetics. METHODS We performed a cross-sectional before-and-after single center sub-study within the multicenter "Provider Education and Evaluation Project" at the Department of Anesthesiology, RWTH Aachen University hospital from May3 2021 to May 1 2022. Educational interventions consisted of stickers, posters and a presentation on climate-smart actions in anesthesiologists' work routine between the first and the second assessment. For each cross-sectional assessment, all central 28 ORs were observed for one week. During the before-and-after comparison we analyzed: 1) energy wasted in unoccupied ORs because of running computers and turned-on lights at 9 p.m.; 2) feasibility of recycling preoperative anesthesia plastic packaging by determining the difference between calculated weight of unseparated preoperative plastic waste in the first assessment and the weight of actual separated waste in the second assessment; 3) fresh gas flow in balanced anesthesia cases in steady state at 9 a.m., and purchased hypnotics converted to bottles/1000 general anesthesia cases in 2018-2022. RESULTS We observed a reduction of wasted energy by 44% in unoccupied ORs. Usage of low fresh gas flow settings increased from 55% to 75%. The average of purchased desflurane in 2018-2020 decreased by 72% in 2022. We calculated 10.33 kg of preoperative plastic waste per week but were unable to implement waste separation for infrastructural and logistical reasons. CONCLUSIONS We found that environment-friendly working behaviors increased after the implementation of educational interventions. The causality between the interventions and the observed improvements remains to be proven.
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Affiliation(s)
- Theresa Dölker
- Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Julia Schuler
- Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Julia Wallqvist
- Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Rolf Rossaint
- Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Ana Kowark
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Sebastian Ziemann
- Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany
| | - Frederick Schneider
- Technical University of Munich, TUM School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany
| | - Adrian A Baumann
- Technical University of Munich, TUM School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany
| | - Neal Conway
- Technical University of Munich, TUM School of Medicine, Department of Anesthesiology and Intensive Care, Munich, Germany
| | - Linda Grüßer
- Department of Anesthesiology, RWTH Aachen University Hospital, Aachen, Germany -
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Breth-Petersen M, Barratt AL, McGain F, Skowno JJ, Zhong G, Weatherall AD, Bell KJL, Pickles KM. Exploring anaesthetists' views on the carbon footprint of anaesthesia and identifying opportunities and challenges for reducing its impact on the environment. Anaesth Intensive Care 2024; 52:91-104. [PMID: 38000001 PMCID: PMC10880423 DOI: 10.1177/0310057x231212211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023]
Abstract
A shift in practice by anaesthetists away from anaesthetic gases with high global warming potential towards lower emission techniques (e.g. total intravenous anaesthesia) could result in significant carbon savings for the health system. The purpose of this qualitative interview study was to understand anaesthetists' perspectives on the carbon footprint of anaesthesia, and views on shifting practice towards more environmentally sustainable options. Anaesthetists were recruited from four hospitals in Western Sydney, Australia. Data were organised according to the capability-opportunity-motivation model of behaviour change. Twenty-eight anaesthetists were interviewed (July-September 2021). Participants' age ranged from 29 to 62 years (mean 43 years), 39% were female, and half had completed their anaesthesia training between 2010 and 2019. Challenges to the wider use of greener anaesthetic agents were identified across all components of the capability-opportunity-motivation model: capability (gaps in clinician skills and experience, uncertainty regarding research evidence); opportunity (norms, time, and resource pressures); and motivation (beliefs, habits, responsibility and guilt). Suggestions for encouraging a shift to more environmentally friendly anaesthesia included access to education and training, implementing guidelines and audit/feedback models, environmental restructuring, improving resource availability, reducing low value care, and building the research evidence base on the safety of alternative agents and their impacts on patient outcomes. We identified opportunities and challenges to reducing the carbon footprint of anaesthesia in Australian hospitals by way of system-level and individual behavioural change. Our findings will be used to inform the development of communication and behavioural interventions aiming to mitigate carbon emissions of healthcare.
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Affiliation(s)
- Matilde Breth-Petersen
- Wiser Healthcare and Healthy Environments and Lives Network, The University of Sydney, Sydney, Australia
| | - Alexandra L Barratt
- Wiser Healthcare and Healthy Environments and Lives Network, The University of Sydney, Sydney, Australia
| | - Forbes McGain
- Western Health Melbourne, University of Melbourne, Melbourne, Australia
| | - Justin J Skowno
- School of Child and Adolescent Health, The University of Sydney, Sydney, Australia
- Department of Anaesthesia, The Children’s Hospital at Westmead, Westmead, Australia
| | - George Zhong
- Department of Anaesthesia, Westmead Hospital, Westmead, Sydney, NSW, Australia
| | - Andrew D Weatherall
- School of Child and Adolescent Health, The University of Sydney, Sydney, Australia
- Department of Anaesthesia, The Children’s Hospital at Westmead, Westmead, Australia
| | - Katy JL Bell
- Wiser Healthcare and Healthy Environments and Lives Network, The University of Sydney, Sydney, Australia
| | - Kristen M Pickles
- Wiser Healthcare and Healthy Environments and Lives Network, The University of Sydney, Sydney, Australia
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Silva MAP, Figueiredo DBS, de Carvalho LR, Braz LG, Braz MG. Modulation of gene expression and influence of gene polymorphisms related to genotoxicity and redox status on occupational exposure to inhaled anesthetics. Int J Hyg Environ Health 2024; 256:114307. [PMID: 38065035 DOI: 10.1016/j.ijheh.2023.114307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
The extensive use of inhalational anesthetics contributes to both indoor and outdoor (environmental) pollution. The influence of genetic susceptibility on DNA damage and oxidative stress and the possible modulation of gene expression have not yet been investigated upon occupational exposure to waste anesthetic gases (WAGs). This study assessed 8-oxoguanine DNA glycosylase 1 (OGG1) and superoxide dismutase 2 (SOD2) gene expression, which are related to oxidized DNA repair and antioxidant capacity, respectively, and the influence of their polymorphisms (OGG1 rs1052133 and SOD2 rs4880) in 100 professionals highly exposed to WAGs and 93 unexposed volunteers (control group). Additionally, X-ray repair cross complementing 1 (XRCC1 rs25487 and rs1799782) and ataxia telangiectasia mutated (ATM rs600931) gene polymorphisms as well as genetic instability (micronucleus-MN and nuclear bud-NBUD) and oxidative stress (malondialdehyde-MDA and ferric reducing antioxidant power-FRAP) biomarkers were assessed in the groups (control and exposed) and in the subgroups of the exposed group according to job occupation (anesthesiologists versus surgeons/technicians). Except for the ATM TT controls (associated with increased FRAP), there were no influences of OGG1, XRCC1, ATM, and SOD2 polymorphisms on MN, NBUD, MDA, and FRAP values in exposed or control subjects. No significant difference in the expression of either gene evaluated (OGG1 and SOD2) was found between the exposed and control groups. Increased OGG1 expression was observed among OGG1 -/Cys individuals only in the control group. Among the exposed group, anesthesiologists had a greater duration of WAG exposure (both h/week and years) than surgeons/technicians, which was associated with increased MDA and decreased antioxidant capacity (FRAP) and SOD2 expression (redox status). Higher expression of OGG1 was found in -/Cys surgeons/technicians than in anesthesiologists with the same genotype. Increased antioxidant capacity was noted in the surgeons/technicians carrying the ATM T allele and in those carrying XRCC1 -/Gln. Increased MN was influenced by OGG1 -/Cys in surgeons/technicians. Anesthesiologists with ATM CC exhibited increased MN, and those carrying the C allele (CC/CT genotype) exhibited increased NBUD. SOD2 polymorphism did not seem to be relevant for WAG exposure. These findings contribute to advancing the knowledge on genetic susceptibility/gene expression/genetic instability/oxidative stress, including differences in job occupation considering the workload, in response to occupational exposure to WAGs.
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Affiliation(s)
- Mariane A P Silva
- GENOTOX Laboratory, Medical School, Sao Paulo State University - UNESP, Botucatu, Brazil
| | - Drielle B S Figueiredo
- GENOTOX Laboratory, Medical School, Sao Paulo State University - UNESP, Botucatu, Brazil
| | - Lídia R de Carvalho
- Institute of Biosciences, Sao Paulo State University - UNESP, Botucatu, Brazil
| | - Leandro G Braz
- GENOTOX Laboratory, Medical School, Sao Paulo State University - UNESP, Botucatu, Brazil
| | - Mariana G Braz
- GENOTOX Laboratory, Medical School, Sao Paulo State University - UNESP, Botucatu, Brazil.
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91
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van Hove M, John JB, Ojelade E, Ayyaz F, Koris J, Frame J, Swart M, Snowden C, Briggs TWR, Gray WK. Unwarranted variation and the goal of net zero for the NHS in England: exploring the link between efficiency working, patient outcomes and carbon footprint. Anaesthesia 2024; 79:284-292. [PMID: 38205537 DOI: 10.1111/anae.16170] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2023] [Indexed: 01/12/2024]
Abstract
In 2020 the NHS in England set a target of reaching net zero carbon emissions by 2040. Progress has already been made towards this goal, with substantial reductions in the use of environmentally harmful anaesthetic gases, such as desflurane, in recent years. Where an effective replacement already exists, changing practice to use low carbon alternatives is relatively easy to achieve, but much greater challenges lie ahead. The Getting It Right First Time (GIRFT) programme is a clinically-led, data-driven clinical improvement initiative with a focus on reducing unwarranted variation in clinical practice and patient outcomes. Reducing unwarranted variation can improve patient care and service efficiency, and can also support the drive to net zero. In this article we set out what the GIRFT programme is doing to support sustainable healthcare in England, why it is uniquely positioned to support this goal and what the future challenges, barriers, enablers and opportunities are likely to be in the drive to net zero.
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Affiliation(s)
- M van Hove
- Getting It Right First Time programme, NHS England, London, UK
- Department of Public Health and Sport Sciences, University of Exeter, Exeter, UK
| | - J B John
- Getting It Right First Time programme, NHS England, London, UK
- Department of Urology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- Exeter University Medical School, University of Exeter, Exeter, UK
| | - E Ojelade
- Getting It Right First Time programme, NHS England, London, UK
- Department of Surgery, Royal National Orthopaedic Hospital, Stanmore, London, UK
| | - F Ayyaz
- Getting It Right First Time programme, NHS England, London, UK
- Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - J Koris
- Trauma Department, John Radcliffe Hospital, Oxford, UK
| | | | - M Swart
- Getting It Right First Time Clinical Lead for Anaesthesia and Perioperative Medicine, Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - C Snowden
- Getting It Right First Time Clinical Lead for Anaesthesia and Perioperative Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle-upon-Tyne, UK
| | - T W R Briggs
- Getting It Right First Time programme, NHS England, London, UK
- NHS England, London, UK
| | - W K Gray
- Getting It Right First Time programme, NHS England, London, UK
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92
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Shah S, Morris H, Nicolaou N, MacInnes S, Haslam P, Shahane S, Ali F, Garcia J. The carbon footprint of arthroscopic procedures. Ann R Coll Surg Engl 2024; 106:256-261. [PMID: 37381779 PMCID: PMC10906500 DOI: 10.1308/rcsann.2023.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 06/30/2023] Open
Abstract
INTRODUCTION The healthcare sector contributes the equivalent of 4.4% of global net emissions to the climate carbon footprint; between 20% and 70% of healthcare waste originates from a hospital's operating theatre and up to 90% of waste is sent for costly and unneeded hazardous waste processing. This study aimed to quantify the amount and type of waste produced during an arthroscopic anterior cruciate ligament reconstruction (ACLR) and an arthroscopic rotator cuff repair (RCR), calculate the carbon footprint and assess the cost of the waste disposal. METHODS The amount of waste generated from ACLR and RCR procedures was calculated across a range of hospital sites. The waste was separated primarily into clean and contaminated, paper or plastic. Both carbon footprint and cost of disposal across the hospital sites was subsequently calculated. RESULTS RCR generated 3.3-15.5kg of plastic waste and 0.9-2.3kg of paper waste. ACLR generated 2.4-9.6kg of plastic waste and 1.1-1.6kg of paper waste. The cost to process waste varies widely between hospital sites, waste disposal contractors and method of waste disposal. The annual burden of the included hospital sites for the arthroscopic procedures undertaken was 6.2 tonnes of carbon dioxide. CONCLUSIONS The data collected demonstrated a significant variability in waste production and cost for waste disposal between hospital sites. At a national level, consideration should be given to the procurement of appropriate products such that waste can be efficiently recycled or disposed of by environmentally sustainable methods.
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Affiliation(s)
| | - H Morris
- East Midlands North Training Rotation, UK
| | - N Nicolaou
- Sheffield Children’s NHS Foundation Trust, UK
| | - S MacInnes
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, UK
| | | | - S Shahane
- Chesterfield Royal Hospital NHS Foundation Trust, UK
| | - F Ali
- Chesterfield Royal Hospital NHS Foundation Trust, UK
| | - J Garcia
- Chesterfield Royal Hospital NHS Foundation Trust, UK
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93
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Ledda V, George C, Glasbey J, Labib P, Li E, Lu A, Kudrna L, Nepogodiev D, Picciochi M, Williams I, Bhangu A. Uncertainties and opportunities in delivering environmentally sustainable surgery: the surgeons' view. Anaesthesia 2024; 79:293-300. [PMID: 38207004 DOI: 10.1111/anae.16195] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 01/13/2024]
Abstract
Surgery is a carbon-heavy activity and creates a high volume of waste. Surgical teams around the world want to deliver more environmentally sustainable surgery but are unsure what to do and how to create change. There are many interventions available, but resources and time are limited. Capital investment into healthcare and engagement of senior management are challenging. However, frontline teams can change behaviours and drive wider change. Patients have a voice here too, as they would like to ensure their surgery does not harm their local community but are concerned about the effects on them when changes are made. Environmentally sustainable surgery is at the start of its journey. Surgeons need to rapidly upskill their generic knowledge base, identify which measures they can implement locally and take part in national research programmes. Surgical teams in the NHS have the chance to create a world-leading programme that can bring change to hospitals around the world. This article provides an overview of how surgeons see the surgical team being involved in environmentally sustainable surgery.
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Affiliation(s)
- V Ledda
- NIHR Programme Grant for Environmentally Sustainable Surgery, Institute of Applied Health Research, University of Birmingham, UK
| | - C George
- Department of Anaesthesia, Christian Medical College and Hospital, Ludhiana, India
| | - J Glasbey
- NIHR Programme Grant for Environmentally Sustainable Surgery, Institute of Applied Health Research, University of Birmingham, UK
| | - P Labib
- NIHR Programme Grant for Environmentally Sustainable Surgery, Institute of Applied Health Research, University of Birmingham, UK
| | - E Li
- NIHR Programme Grant for Environmentally Sustainable Surgery, Institute of Applied Health Research, University of Birmingham, UK
| | - A Lu
- Department of Anaesthesia, North West School of Anaesthesia, Manchester, UK
| | - L Kudrna
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - D Nepogodiev
- NIHR Programme Grant for Environmentally Sustainable Surgery, Institute of Applied Health Research, University of Birmingham, UK
| | - M Picciochi
- NIHR Programme Grant for Environmentally Sustainable Surgery, Institute of Applied Health Research, University of Birmingham, UK
| | - I Williams
- School of Social Policy, University of Birmingham, Birmingham, UK
| | - A Bhangu
- NIHR Programme Grant for Environmentally Sustainable Surgery, Institute of Applied Health Research, University of Birmingham, UK
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94
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Dilger AE, Shelley J, Bergmark RW, Slutzman JE. Addressing Climate Health: A Practical Guide to Quantifying and Reducing Health Care-Associated Emissions. Otolaryngol Head Neck Surg 2024; 170:981-986. [PMID: 38044482 DOI: 10.1002/ohn.603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/31/2023] [Accepted: 11/11/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE The objective was to quantify annual greenhouse gas emissions from a surgical specialty hospital and identify high-yield areas to reduce emissions associated with patient care. STUDY DESIGN Pre-post study, greenhouse gas inventory. SETTING Specialty hospital. METHODS A scope 1 and scope 2 greenhouse gas inventory of the Massachusetts Eye and Ear main campus for calendar years (CY) 2020, 2021, and 2022 was performed by assessing emissions attributable to on-site sources (scope 1) and purchased electricity and steam (scope 2). The associated carbon dioxide equivalent was then calculated using known global warming potentials and emission factors. RESULTS The major contributors to scope 1 and scope 2 emissions at our institution for CY 2020 to 2022 were waste anesthetic gases and purchased steam. These results were reviewed with hospital leadership and a plan was developed to reduce these emissions. Emission monitoring is ongoing to assess the efficacy of these interventions. CONCLUSION Measuring scope 1 and scope 2 emissions at the facility level allows health care facilities to develop institution-specific interventions and compare data across health care organizations. Surgeons can lead on health care system sustainability by collaborating with clinical and nonclinical staff to measure emissions, developing targeted emissions-reduction interventions, and tracking progress with yearly assessments.
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Affiliation(s)
- Amanda E Dilger
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jekaterina Shelley
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA
| | - Regan W Bergmark
- Department of Otolaryngology-Head and Neck Surgery, Harvard Medical School, Boston, Massachusetts, USA
- Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Otolaryngology-Head and Neck Surgery, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, Massachusetts, USA
| | - Jonathan E Slutzman
- Center for the Environment and Health, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
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95
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Jacob S, Schust SA, Angele M, Werner J, Guba M, Börner N. A long road ahead. A German national survey study on awareness and willingness of surgeons towards the carbon footprint of modern surgical procedures. Heliyon 2024; 10:e25198. [PMID: 38327395 PMCID: PMC10847866 DOI: 10.1016/j.heliyon.2024.e25198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/09/2024] Open
Abstract
Background Climate change may well be the "largest threat" to humankind. Changes to our climate system lead to a decrease in global health. The healthcare sector presents one of the largest carbon footprints across all industries. Since surgical departments have one of the largest carbon footprints within the healthcare sector, they represent an area with vast opportunities for improvement. To drive change, it is vital to create awareness of these issues and encourage engagement in changes among people working in the healthcare industry. Methods We conducted an anonymous cross-sectional survey study to assess awareness among surgeons regarding the impact of healthcare systems on climate change. The questions were designed to investigate surgeons' willingness to accept and promote changes to reduce carbon footprints. Participants included surgical professionals of all ages and levels of expertise. Results A total of 210 participants completed the survey in full and were included in the evaluation. Sixty percent emphasized a lack of information and the need for personal education. Over 90 % expressed concern for the environment and a strong desire to gain new insights. Provided that clinical performance remains the same, more than 70 % are willing to embrace carbon-friendly alternatives. In this context, all participants accepted the additional time required for training and initially increased personal efforts to achieve equal performance. Conclusion Limited awareness and information about carbon footprints were observed in surgical departments in German hospitals. Nevertheless, the vast majority of surgeons across all age groups are more than willing to acquire new insights and adapt to changes in order to reduce energy consumption and carbon dioxide production.
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Affiliation(s)
- Sven Jacob
- Ludwig-Maximilians-University, Department of General, Visceral and Transplantation Surgery, Munich, Germany
| | - Sophie Anne Schust
- Ludwig-Maximilians-University, Department of General, Visceral and Transplantation Surgery, Munich, Germany
| | - Martin Angele
- Ludwig-Maximilians-University, Department of General, Visceral and Transplantation Surgery, Munich, Germany
| | - Jens Werner
- Ludwig-Maximilians-University, Department of General, Visceral and Transplantation Surgery, Munich, Germany
| | - Markus Guba
- Ludwig-Maximilians-University, Department of General, Visceral and Transplantation Surgery, Munich, Germany
| | - Nikolaus Börner
- Ludwig-Maximilians-University, Department of General, Visceral and Transplantation Surgery, Munich, Germany
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96
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Bernicker E, Averbuch SD, Edge S, Kamboj J, Khuri FR, Pierce JY, Schiller J, Sirohi B, Thomas A, Moushey A, Phillips J, Hendricks C. Climate Change and Cancer Care: A Policy Statement From ASCO. JCO Oncol Pract 2024; 20:178-186. [PMID: 38011607 DOI: 10.1200/op.23.00637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 11/29/2023] Open
Affiliation(s)
| | | | - Stephen Edge
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | | | | | | | | | | | - Allyn Moushey
- American Society of Clinical Oncology, Alexandria, VA
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97
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Meiklejohn DA, Khan ZH, Nuñez KM, Imhof L, Osmani S, Benavidez AC, Tarefder R. Environmental Impact of Adult Tonsillectomy: Life Cycle Assessment and Cost Comparison of Techniques. Laryngoscope 2024; 134:622-628. [PMID: 37421241 DOI: 10.1002/lary.30866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES To quantify and compare the cost and environmental impact of different techniques for adult tonsillectomy surgery, and to identify target areas for impact reduction. METHODS Fifteen consecutive adult tonsillectomy surgeries were prospectively randomized to one of three tonsillectomy techniques: cold, monopolar electrocautery, or low-temperature radiofrequency ablation (Coblation). Life cycle assessment was used to comprehensively evaluate the environmental impact of study surgeries. Outcomes assessed included multiple measures of environmental impact, including greenhouse gas (GHG) emissions, and cost. Environmental impact measures were analyzed to identify highest-yield areas for improvement, and outcomes were compared between surgical techniques using statistical analysis. RESULTS GHG emissions for cold, monopolar electrocautery, and Coblation techniques were 157.6, 184.5, and 204.7 kilograms of carbon dioxide equivalents (kgCO2 -eq) per surgery, respectively, with costs totaling $472.51, $619.10, and $715.53 per surgery, respectively. Regardless of surgery technique, anesthesia medications and disposable equipment contributed most to environmental harm. Cold technique demonstrated reduced environmental impact related to disposable surgical equipment in the categories of greenhouse gas emissions, acidification of soil and water, eutrophication of air, ozone depletion, release of carcinogenic, and non-carcinogenic toxic substances, and respiratory pollutant production (p < 0.05 for all comparisons with other techniques). CONCLUSION Within the boundaries of operating room processes, cold technique minimizes cost and environmental impact of adult tonsillectomy surgery, with statistical significance noted in the impact of disposable surgical equipment. Areas of highest potential for improvement identified include reducing use of disposable equipment and collaboration with the Anesthesiology care team to streamline medication use. LEVEL OF EVIDENCE 2, randomized trial Laryngoscope, 134:622-628, 2024.
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Affiliation(s)
- Duncan A Meiklejohn
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico Hospital, Albuquerque, New Mexico, U.S.A
| | - Zafrul H Khan
- Department of Civil Engineering, University of New Mexico, Albuquerque, New Mexico, U.S.A
| | - Karyn M Nuñez
- Alaska Native Tribal Health Consortium, Providence Anchorage Anesthesia Medical Group, Anchorage, Alaska, U.S.A
| | - Lee Imhof
- Department of Planning and Construction, University of New Mexico Hospital, Albuquerque, New Mexico, U.S.A
| | - Sabah Osmani
- University of New Mexico School of Medicine, Albuquerque, New Mexico, U.S.A
| | - Amaris C Benavidez
- University of New Mexico School of Medicine, Albuquerque, New Mexico, U.S.A
| | - Rafiqul Tarefder
- Department of Civil Engineering, University of New Mexico, Albuquerque, New Mexico, U.S.A
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98
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Rougereau G, Chatelain L, Zadegan F, Conso C. Estimation of the carbon footprint of arthroscopic rotator cuff repairs in France. Orthop Traumatol Surg Res 2024; 110:103755. [PMID: 37949395 DOI: 10.1016/j.otsr.2023.103755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 06/20/2023] [Accepted: 06/30/2023] [Indexed: 11/12/2023]
Abstract
AIM The main objective of this study was to estimate the carbon impact of arthroscopic rotator cuff repairs in France. The secondary objective was to assess the effectiveness of the following measures in reducing the carbon footprint associated with this technique: outpatient treatment, arthroscopic water filtration, surgery under locoregional anesthesia. HYPOTHESIS The hypothesis was that the carbon footprint could be significantly improved with the implementation of these three procedures. METHODS A continuous series of 26 patients who underwent surgery for a rotator cuff tear involving only one tendon between November 2020 and April 2021 were included. The evaluation protocol consisted of three parts: 1/ use of volatile anesthetic agents; 2/ electrical consumption linked to the procedure; 3/ emissions related to patient and staff travel, delivery of implants and waste management. Another series of 26 patients operated between November 2018 and April 2019 who had none of these three factors were matched. RESULTS The carbon impact of arthroscopic repair of the rotator cuff was estimated at 334.61±18.82kgCO2eq. The implementation of the three methods for improvement made it possible to significantly reduce emissions by 40.9±1.71kgCO2eq (12.2%) (p<0.001). CONCLUSION Performing surgery under locoregional anesthesia, on an outpatient basis with water purification, reduces the carbon impact of arthroscopic rotator cuff repair by more than 12%. LEVEL OF EVIDENCE III, retrospective case control.
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Affiliation(s)
- Grégoire Rougereau
- Service de chirurgie orthopédique, Institut Mutualiste Montsouris, Paris, France; Service de chirurgie orthopédique et traumatologique, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France.
| | - Léonard Chatelain
- Service de chirurgie orthopédique, Institut Mutualiste Montsouris, Paris, France
| | - Frédéric Zadegan
- Service de chirurgie orthopédique, Institut Mutualiste Montsouris, Paris, France
| | - Christel Conso
- Service de chirurgie orthopédique, Institut Mutualiste Montsouris, Paris, France
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99
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Dargent J. Reducing greenhouse gas emissions in a bariatric surgical unit is a complex but feasible project. Sci Rep 2024; 14:1252. [PMID: 38218989 PMCID: PMC10787753 DOI: 10.1038/s41598-024-51441-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 01/04/2024] [Indexed: 01/15/2024] Open
Abstract
Obesity is a growing issue worldwide, whose causes and consequences are linked to the environment and which therefore has a high carbon footprint. On the other hand, obesity surgery, along with other procedures in surgical suites, entails environmental consequences and responsibilities. We conducted a prospective comparative study on two groups of bariatric interventions (N = 59 and 56, respectively) during two consecutive periods of time (Oct 2021-March 2022), first without and then with specific measures aimed at reducing greenhouse gas emissions related to bariatric procedures by approximately 18%. These measures included recycling of disposable surgical equipment, minimizing its use, and curbing anesthetic gas emissions. Further and continuous efforts/incentives are warranted, including reframing the surgical strategies. Instead of comparing measurements, which is difficult at the present time, we suggest defining an ECO-SCORE in operating rooms, among other healthcare facilities.
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Affiliation(s)
- Jerome Dargent
- Polyclinique de Rillieux, 65 Rue des Contamines, 69140, Rillieux-la-Pape, France.
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100
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Parker EB, Bluman EM, Chiodo CP, Martin EA, Smith JT. Carbon Footprint of Minor Foot and Ankle Surgery: A Randomized Controlled Trial. FOOT & ANKLE ORTHOPAEDICS 2024; 9:24730114241238231. [PMID: 38510517 PMCID: PMC10952996 DOI: 10.1177/24730114241238231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Background Climate change poses a substantial threat to human health, and operating rooms (ORs) have an outsized environmental impact. The Program for Research in Sustainable Medicine (PRiSM) designed a protocol for minor foot and ankle surgery intended to reduce waste, streamline instrument trays, and minimize laundry. We conducted a randomized controlled trial to compare the carbon footprint of procedures performed using the PRiSM protocol vs a traditional protocol. Methods Forty adult patients undergoing foreign body removal, hammertoe correction, toe amputation, hardware removal, mass excision, or gastrocnemius recession were randomized to the PRiSM or our "Traditional" protocol. The PRiSM protocol used a smaller instrument tray, fewer drapes and towels, and minimal positioning blankets. No changes were made to surgical site preparation or operative techniques. Environmental impact was estimated using the carbon footprint, measured in kilograms of carbon dioxide equivalents (CO2e). Emissions associated with OR waste, instrument processing, and laundry were calculated. Results On average, PRiSM cases had a smaller carbon footprint than Traditional cases (17.3 kg CO2e [SD = 3.2] vs 20.6 kg CO2e [SD = 2.0], P < .001). Waste-associated emissions from PRiSM cases were reduced (16.0 kg CO2e [SD = 2.7] vs 18.4 kg CO2e [SD = 1.8], P = .002), as were modeled instrument processing-related emissions (0.34 vs 0.91 kg CO2e). One superficial surgical site infection occurred in each group. Conclusion We found a small but statistically significant reduction in the environmental impact of minor foot and ankle surgery when using the PRiSM vs Traditional protocol. The environmental impact of these cases was dominated by plastic waste-related emissions. Orthopaedic surgeons should think critically about what components of their surgical setup are truly necessary for patient care, as minor changes in product utilization can have significant impacts on waste and greenhouse gas emissions. Level of Evidence Level I, randomized controlled trial.
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Affiliation(s)
- Emily B. Parker
- Harvard Medical School, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Eric M. Bluman
- Harvard Medical School, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Christopher P. Chiodo
- Harvard Medical School, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Elizabeth A. Martin
- Harvard Medical School, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jeremy T. Smith
- Harvard Medical School, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
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