1
|
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.
Collapse
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
| |
Collapse
|
2
|
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.
Collapse
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
| |
Collapse
|
3
|
Sathe TS, Sorrentino TA, Wang K, Yap A, Wang JJ, Matthys M, Yin R, Alseidi A, Lee H, Gandhi S. Instrument and Supply Variability: An Opportunity to Reduce the Carbon Footprint of the Operating Room. J Surg Res 2024; 295:732-739. [PMID: 38142576 DOI: 10.1016/j.jss.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] [Received: 07/17/2023] [Revised: 10/16/2023] [Accepted: 11/07/2023] [Indexed: 12/26/2023]
Abstract
INTRODUCTION Reducing costs and carbon footprints are important, parallel priorities for the US health-care system. Within surgery, reducing the number of instruments that are sterilized and disposable supplies that are used for each operation may help achieve both goals. We wanted to measure the existing variability in surgical instrument and supply choices and assess whether standardization could have a meaningful cost and environmental impact. METHODS We analyzed surgeon preference cards for common general surgery operations at our hospital to measure the number of sterilizable instrument trays and supplies used by each surgeon for each operation. From this data, we calculated supply costs, carbon footprint, and median operative time and studied the variability in each of these metrics. RESULTS Among the ten operations studied, variability in sterilizable instrument trays requested on surgeon preference cards ranged from one to eight. Variability in disposable supplies requested ranged from 17 to 45. Variability in open supply costs ranged from $104 to $4184. Variability in carbon footprint ranged from 17 to 708 kg CO2e. If the highest-cost surgeon for each operation switched their preference card to that of the median-cost surgeon, $245,343 in open supply costs and 41,708 kg CO2e could be saved. CONCLUSIONS There is significant variability in the instrument and supply choices of surgeons performing common general surgery operations. Standardizing this variability may lead to meaningful cost savings and carbon footprint reduction, especially if scaled across the entire health system.
Collapse
Affiliation(s)
- Tejas S Sathe
- Department of Surgery, University of California San Francisco, San Francisco, California.
| | - Thomas A Sorrentino
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Kaiyi Wang
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Ava Yap
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Jaeyun Jane Wang
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Madeline Matthys
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Raymond Yin
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Adnan Alseidi
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Hanmin Lee
- Department of Surgery, University of California San Francisco, San Francisco, California
| | - Seema Gandhi
- Department of Anesthesiology, University of California San Francisco, San Francisco, California
| |
Collapse
|
4
|
Leboulanger N, Camhi Y, Le Clerc N, Lesnik M, Mazzaschi O, Veyrat M, Gardini B. French otorhinolaryngologists, actors for sustainable development. Eur Ann Otorhinolaryngol Head Neck Dis 2023; 140:207-208. [PMID: 37336715 DOI: 10.1016/j.anorl.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Affiliation(s)
- N Leboulanger
- Service d'oto-rhino-laryngologie, hôpital Necker-Enfants malades, AP-HP, université Paris Cité, 75015 Paris, France.
| | - Y Camhi
- Service d'oto-rhino-laryngologie, Fondation ophtalmologique de Rothschild, 75019 Paris, France
| | - N Le Clerc
- Service d'oto-rhino-laryngologie, hôpital Lariboisière, AP-HP, 75010 Paris, France
| | - M Lesnik
- Service d'oto-rhino-laryngologie, Institut Curie, 75005 Paris, France
| | - O Mazzaschi
- Service d'oto-rhino-laryngologie, hôpital St-Joseph, 75014 Paris, France
| | - M Veyrat
- Service d'oto-rhino-laryngologie, Fondation ophtalmologique de Rothschild, 75019 Paris, France
| | - B Gardini
- ORL, Clinique Sarrus Teinturier, 31300 Toulouse, France
| |
Collapse
|
5
|
Nazir A, Ma X, Vervoort D. Environmentally sustainable surgical health systems: an analysis of policies, tools, and guidelines. Lancet Planet Health 2023; 7:e538-e539. [PMID: 37437993 DOI: 10.1016/s2542-5196(23)00124-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/26/2023] [Indexed: 07/14/2023]
Affiliation(s)
- Anisa Nazir
- Institute of Medical Sciences, University of Toronto, Toronto, ON M5S 1A8, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada.
| | - Xiya Ma
- Division of Plastic Surgery, Université de Montréal, Montréal, QC, Canada
| | - Dominique Vervoort
- Division of Cardiac Surgery, University of Toronto, Toronto, ON M5S 1A8, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON M5S 1A8, Canada
| |
Collapse
|
6
|
Sherry B, Lee S, Ramos Cadena MDLA, Laynor G, Patel SR, Simon MD, Romanowski EG, Hochman SE, Schuman JS, Prescott C, Thiel CL. How Ophthalmologists Can Decarbonize Eye Care: A Review of Existing Sustainability Strategies and Steps Ophthalmologists Can Take. Ophthalmology 2023; 130:702-714. [PMID: 36889466 PMCID: PMC10293062 DOI: 10.1016/j.ophtha.2023.02.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/13/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
TOPIC Understanding approaches to sustainability in cataract surgery and their risks and benefits. CLINICAL RELEVANCE In the United States, health care is responsible for approximately 8.5% of greenhouse gas (GHG), and cataract surgery is one of the most commonly performed surgical procedures. Ophthalmologists can contribute to reducing GHG emissions, which lead to a steadily increasing list of health concerns ranging from trauma to food instability. METHODS We conducted a literature review to identify the benefits and risks of sustainability interventions. We then organized these interventions into a decision tree for use by individual surgeons. RESULTS Identified sustainability interventions fall into the domains of advocacy and education, pharmaceuticals, process, and supplies and waste. Existing literature shows certain interventions may be safe, cost-effective, and environmentally friendly. These include dispensing medications at home to patients after surgery, multi-dosing appropriate medications, training staff to properly sort medical waste, reducing the number of supplies used during surgery, and implementing immediate sequential bilateral cataract surgery where clinically appropriate. The literature was lacking on the benefits or risks for some interventions, such as switching specific single-use supplies to reusables or implementing a hub-and-spoke-style operating room setup. Many of the advocacy and education interventions have inadequate literature specific to ophthalmology but are likely to have minimal risks. CONCLUSIONS Ophthalmologists can engage in a variety of safe and effective approaches to reduce or eliminate dangerous GHG emissions associated with cataract surgery. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
Collapse
Affiliation(s)
- Brooke Sherry
- NYU Langone Health, NYU Langone Hospitals, New York, New York
| | - Samuel Lee
- NYU Langone Health, NYU Langone Hospitals, New York, New York
| | | | - Gregory Laynor
- NYU Langone Health, NYU Langone Hospitals, New York, New York
| | - Sheel R Patel
- NYU Langone Health, NYU Langone Hospitals, New York, New York
| | | | - Eric G Romanowski
- Research Director of The Charles T. Campbell Ophthalmic Microbiology Laboratory, Department of Ophthalmology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Sarah E Hochman
- NYU Langone Health, NYU Langone Hospitals, New York, New York; Department of Medicine, Division of Infectious Diseases and Immunology, NYU Grossman School of Medicine, New York, New York
| | - Joel S Schuman
- NYU Langone Health, NYU Langone Hospitals, New York, New York; Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York; Center for Neural Science, College of Arts and Science, New York University, New York, New York; Departments of Biomedical Engineering and Electrical & Computer Engineering, Tandon School of Engineering, New York University, New York, New York; Neuroscience Institute, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York
| | - Christina Prescott
- NYU Langone Health, NYU Langone Hospitals, New York, New York; Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York
| | - Cassandra L Thiel
- NYU Langone Health, NYU Langone Hospitals, New York, New York; Department of Ophthalmology, NYU Grossman School of Medicine, NYU Langone Health, New York University, New York, New York.
| |
Collapse
|
7
|
Mubarak FS. Sustainable Healthcare to Provide Quality Care in the Surgical Industry in the United Kingdom. Cureus 2023; 15:e38156. [PMID: 37252547 PMCID: PMC10218761 DOI: 10.7759/cureus.38156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
The surgical industry makes a major contribution to sustainable healthcare. This article aims to critically evaluate sustainable healthcare to provide quality surgical care in the United Kingdom. For this study, a systematic review was conducted using peer-reviewed studies and articles from the United Kingdom related to surgical and anesthetic fields that were published within the last five years. The journal articles were selected based on their relevance to the sustainability and performance of the healthcare system, including risks, and subsequently screened using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 model screening approach. The findings of the relevant journal articles were then critically evaluated for each theme. A total of 79 studies were retrieved, and 15 of the retrieved studies met the inclusion criteria. Of those, 10 articles evaluated existing sustainability practices, only seven articles discussed significant determinants of quality healthcare, and only 86.67% of the articles highlighted the implications of sustainability. The key predictors of high-quality medical care are effective resource management, the acquisition of a moral surgical team, the provision of professional services, integration, short hospital stays, and low mortality and morbidity rates. Conserving water, optimizing treatment routes and transportation, and creating cultural change were found to be the pillars of high-quality, sustainable healthcare. The concept of sustainability varied between these studies, and limitations on sustainability as a result of reduced mortality, morbidity, and business services were observed. Anesthetic gas emissions from operating rooms continue to have the most detrimental effect on the sustainability of the surgical industry. A significant gap was noted between the available data and their implications.
Collapse
|
8
|
Shao C, Tsai S, Woo R, Dream S. Becoming a Sustainable Academic Surgeon. J Surg Res 2023; 283:606-610. [PMID: 36442260 DOI: 10.1016/j.jss.2022.10.091] [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: 07/21/2022] [Revised: 09/30/2022] [Accepted: 10/17/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Health care facilities represent a significant source of pollution, contributing to the growing problems associated with global warming. The resulting climate change impacts our health through worsening air and water quality, diminished access to nutritious food, and safe shelter. METHODS We outline here the not only the role of the surgeon in contributing to climate change, but also ways in which to minimize one's carbon footprint. RESULTS Surgeons are leaders within healthcare systems. Adopting environmentally conscious practices can reduce solid waste, energy usage, and carbon emissions. Practices outside of the clinical setting can also incorporate sustainability, including the use of virtual recruitment and educational programs, as well as thoughtful and conscientious travel practices. CONCLUSIONS Academic surgery combines clinical practice with an element of leadership, at all levels. Our recognition and action to reduce wasteful practices can help leave a better earth for generations to come.
Collapse
Affiliation(s)
- Connie Shao
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - Susan Tsai
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Russell Woo
- Department of Surgery, University of Hawai'I, John A. Burns School of Medicine, Honolulu, Hawaii
| | - Sophie Dream
- Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| |
Collapse
|
9
|
Sullivan GA, Petit HJ, Reiter AJ, Westrick JC, Hu A, Dunn JB, Gulack BC, Shah AN, Dsida R, Raval MV. Environmental Impact and Cost Savings of Operating Room Quality Improvement Initiatives: A Scoping Review. J Am Coll Surg 2023; 236:411-423. [PMID: 36648269 DOI: 10.1097/xcs.0000000000000478] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Operating rooms are major contributors to a hospital's carbon footprint due to the large volumes of resources consumed and waste produced. The objective of this study was to identify quality improvement initiatives that aimed to reduce the environmental impact of the operating room while decreasing costs. STUDY DESIGN A literature search was performed using PubMed, Scopus, CINAHL, and Google Scholar and included broad terms for "operating room," "costs," and "environment" or "sustainability." The "triple bottom line" framework, which considers the environmental, financial, and social impacts of interventions to guide decision making, was used to inform data extraction. The studies were then categorized using the 5 "Rs" of sustainability-refuse, reduce, reuse, repurpose, and recycle-and the impacts were discussed using the triple bottom line framework. RESULTS A total of 23 unique quality improvement initiatives describing 28 interventions were included. Interventions were categorized as "refuse" (n = 11; 39.3%), "reduce" (n = 8; 28.6%), "reuse" (n = 3; 10.7%), and "recycle" (n = 6; 21.4%). While methods of measuring environmental impact and cost savings varied greatly among studies, potential annual cost savings ranged from $873 (intervention: education on diverting recyclable materials from sharps containers; environmental impact: 11.4 kg sharps waste diverted per month) to $694,141 (intervention: education to reduce regulated medical waste; environmental impact: 30% reduction in regulated medical waste). CONCLUSIONS Quality improvement initiatives that reduce both cost and environmental impact have been successfully implemented across a variety of centers both nationally and globally. Surgeons, healthcare practitioners, and administrators interested in environmental stewardship and working toward a culture of sustainability may consider similar interventions in their institutions.
Collapse
Affiliation(s)
- Gwyneth A Sullivan
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
| | - Hayley J Petit
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
| | - Audra J Reiter
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
| | - Jennifer C Westrick
- the Library of Rush Medical Center (Westrick), Rush University Medical Center, Chicago, IL
| | - Andrew Hu
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
| | - Jennifer B Dunn
- the Chemical and Biological Engineering, Northwestern University, Evanston, IL (Dunn)
| | - Brian C Gulack
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
- the Department of Anesthesiology (Dsida), Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
- the Library of Rush Medical Center (Westrick), Rush University Medical Center, Chicago, IL
- the Chemical and Biological Engineering, Northwestern University, Evanston, IL (Dunn)
| | - Ami N Shah
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
- the Department of Anesthesiology (Dsida), Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
- the Division of Pediatric Surgery, Department of Surgery (Sullivan, Petit)
- the Library of Rush Medical Center (Westrick), Rush University Medical Center, Chicago, IL
- the Chemical and Biological Engineering, Northwestern University, Evanston, IL (Dunn)
| | - Richard Dsida
- the Department of Anesthesiology (Dsida), Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL
| | - Mehul V Raval
- From the Division of Pediatric Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine (Sullivan, Reiter, Hu, Raval)
| |
Collapse
|
10
|
Niebel D, Herrmann A, Balzer S, Hecker C, Koch S, Luhmann E, Becker-Weimann SY, Tischler M, Löffler C, Saha S. Nachhaltigkeit in der dermatologischen Praxis und Klinik: Herausforderungen und Lösungsansätze. J Dtsch Dermatol Ges 2023; 21:44-58. [PMID: 36721932 DOI: 10.1111/ddg.14952_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 10/17/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Dennis Niebel
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Regensburg.,AG Nachhaltigkeit in der Dermatologie e.V. (AGN) der Deutschen Dermatologischen Gesellschaft (DDG), Freiburg
| | - Alina Herrmann
- Institut für Global Health, Universitätsklinikum Heidelberg, Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM)
| | - Susanne Balzer
- Hausarztpraxis Dres. Metz & Balzer, Köln, Ressort Klimaschutz in der AG hausärztliche Internisten der Deutschen Gesellschaft für Innere Medizin (DGIM)
| | - Christina Hecker
- AG Nachhaltigkeit in der Dermatologie e.V. (AGN) der Deutschen Dermatologischen Gesellschaft (DDG), Freiburg
| | - Susanne Koch
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Forum für Nachhaltigkeit der Deutschen Gesellschaft für Anästhesiologie & Intensivmedizin (DGAI)
| | - Esther Luhmann
- Verein demokratischer Pharmazeutinnen und Pharmazeuten (VdPP), Hamburg
| | - Su Youn Becker-Weimann
- AG Nachhaltigkeit in der Dermatologie e.V. (AGN) der Deutschen Dermatologischen Gesellschaft (DDG), Freiburg.,Klinik für Dermatologie, Allergologie und Venerologie, Universitätsklinikum Frankfurt, Frankfurt am Main
| | - Max Tischler
- AG Nachhaltigkeit in der Dermatologie e.V. (AGN) der Deutschen Dermatologischen Gesellschaft (DDG), Freiburg.,Hautärzte am Markt, Dortmund, Junge Dermatologen (JuDerm) im Berufsverband der Deutschen Dermatologen (BVDD)
| | - Christin Löffler
- AG Nachhaltigkeit in der Dermatologie e.V. (AGN) der Deutschen Dermatologischen Gesellschaft (DDG), Freiburg.,Klinik für Dermatologie, Allergologie und Phlebologie, SLK-Kliniken Heilbronn
| | - Susanne Saha
- AG Nachhaltigkeit in der Dermatologie e.V. (AGN) der Deutschen Dermatologischen Gesellschaft (DDG), Freiburg
| |
Collapse
|
11
|
Niebel D, Herrmann A, Balzer S, Hecker C, Koch S, Luhmann E, Becker-Weimann SY, Tischler M, Löffler C, Saha S. Sustainability of dermatological offices and clinics: challenges and potential solutions. J Dtsch Dermatol Ges 2023; 21:44-58. [PMID: 36721934 DOI: 10.1111/ddg.14952] [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: 06/03/2022] [Accepted: 10/17/2022] [Indexed: 02/02/2023]
Abstract
Ongoing high consumption of resources results in exceeding the planetary boundaries. Modern healthcare systems contribute to this problem. To address this issue, this article provides an overview of various aspects of sustainable actions in medical offices and clinics that can also be applied to dermatology. Specific fields of action include energy consumption, structural measures, traffic and mobility, organization including digitalization as well as personnel and evaluation. Moreover, we discuss specific topics such as hygiene and cleansing, dermatosurgery and prescription practices. External treatments and cosmetics are discussed separately as dermatological peculiarities. Finally, we provide information on established initiatives for more sustainable health care in Germany. We aim to encourage critical reappraisal of currently established practices and to stimulate the implementation of sustainable measures.
Collapse
Affiliation(s)
- Dennis Niebel
- Department of Dermatology, University Hospital Regensburg, Regensburg, Germany.,AG Nachhaltigkeit in der Dermatologie e.V. (AGN) der Deutschen Dermatologischen Gesellschaft (DDG), Freiburg, Germany
| | - Alina Herrmann
- Institute for Global Health, University Hospital Heidelberg, Heidelberg, Germany; Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM)
| | - Susanne Balzer
- Hausarztpraxis Drs. Metz & Balzer, Cologne, Germany; Department of Climate Protection in AG Hausärztliche Internisten of the Deutsche Gesellschaft für Innere Medizin (DGIM)
| | - Christina Hecker
- AG Nachhaltigkeit in der Dermatologie e.V. (AGN) der Deutschen Dermatologischen Gesellschaft (DDG), Freiburg, Germany
| | - Susanne Koch
- Department of Anesthesiology with Focus on Surgical Intensive Care, Charité - Universitätsmedizin Berlin, Berlin, Germany; Forum for Sustainability of the Deutsche Gesellschaft für Anästhesiologie & Intensivmedizin (DGAI)
| | - Esther Luhmann
- Verein demokratischer Pharmazeutinnen und Pharmazeuten (VdPP), Hamburg, Germany
| | - Su Youn Becker-Weimann
- AG Nachhaltigkeit in der Dermatologie e.V. (AGN) der Deutschen Dermatologischen Gesellschaft (DDG), Freiburg, Germany.,Department of Dermatology, Allergology and Venereology, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Max Tischler
- AG Nachhaltigkeit in der Dermatologie e.V. (AGN) der Deutschen Dermatologischen Gesellschaft (DDG), Freiburg, Germany.,Hautärzte am Markt, Dortmund, Germany; Junge Dermatologen (JuDerm) in Berufsverband der Deutschen Dermatologen (BVDD)
| | - Christin Löffler
- AG Nachhaltigkeit in der Dermatologie e.V. (AGN) der Deutschen Dermatologischen Gesellschaft (DDG), Freiburg, Germany.,Department of Dermatology, Allergology and Phlebology, SLK-Kliniken Heilbronn, Germany
| | - Susanne Saha
- AG Nachhaltigkeit in der Dermatologie e.V. (AGN) der Deutschen Dermatologischen Gesellschaft (DDG), Freiburg, Germany
| |
Collapse
|
12
|
Cunha MF, Pellino G. Environmental effects of surgical procedures and strategies for sustainable surgery. Nat Rev Gastroenterol Hepatol 2022; 20:399-410. [PMID: 36481812 PMCID: PMC9735025 DOI: 10.1038/s41575-022-00716-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 12/13/2022]
Abstract
There is a bidirectional relationship between climate change and health care. Climate change threatens public health, and health care contributes to climate change. For example, surgery is the most energy-intensive practice in the health-care sector, and gastrointestinal conditions are responsible for a substantial environmental burden. However, environmental costs associated with health care are often overlooked. This issue has been examined more closely in current times. Emerging data are mainly focused on surgery, as the most resource-intensive practice. However, there is still a lack of global awareness and guidance on sustainable surgical practices. This Perspective aims to reassess the evidence on health care and surgery carbon footprints, focusing on gastrointestinal conditions, identify issues that need to be addressed to achieve a more sustainable practice and develop perspectives for future surgical procedures. The proposed framework to mitigate the environmental effects of surgery could be translated to other health-care sectors.
Collapse
Affiliation(s)
- Miguel F. Cunha
- grid.7157.40000 0000 9693 350XColorectal Surgery group - General Surgery Department, Algarve University Centre, Portimão, Portugal ,Algarve Biomedical Centre, Portimão, Portugal
| | - Gianluca Pellino
- grid.9841.40000 0001 2200 8888Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy ,grid.411083.f0000 0001 0675 8654Colorectal Surgery, Vall d’Hebron University Hospital, Barcelona, Spain
| |
Collapse
|
13
|
Zaigham M, Bryce-Alberti M, Calderon C, Campos LN, Raguveer V, Nuss S, Dutta R, Naus AE, Forbes C, Park KB, McClain CD. The time to act is now: a call to action on planetary health and sustainable surgical systems. Lancet Planet Health 2022; 6:e931-e932. [PMID: 36370731 DOI: 10.1016/s2542-5196(22)00261-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/19/2022] [Indexed: 06/16/2023]
Affiliation(s)
- Mehreen Zaigham
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Obstetrics and Gynecology Institution of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - Mayte Bryce-Alberti
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Chrystal Calderon
- Faculty of Medical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Letícia Nunes Campos
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Faculty of Medical Sciences, Universidade de Pernambuco, Recife, Brazil
| | - Vanitha Raguveer
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; University of Illinois College of Medicine, Chicago, IL, USA
| | - Sarah Nuss
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Warren Alpert Medical School at Brown University, Providence, RI, USA
| | - Rohini Dutta
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Mary Horigan Connor's Centre for Gender and Reproductive Biology, Brigham and Women's Hospital, Boston, MA, USA
| | - Abbie E Naus
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Callum Forbes
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; University of Global Health Equity, Kigali, Rwanda
| | - Kee B Park
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA
| | - Craig D McClain
- Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA 02115, USA; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| |
Collapse
|
14
|
Shum PL, Kok HK, Maingard J, Zhou K, Van Damme V, Barras CD, Slater LA, Chong W, Chandra RV, Jhamb A, Brooks M, Asadi H. Sustainability in interventional radiology: are we doing enough to save the environment? CVIR Endovasc 2022; 5:60. [PMCID: PMC9703417 DOI: 10.1186/s42155-022-00336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/31/2022] [Indexed: 11/29/2022] Open
Abstract
Abstract
Background
Healthcare waste contributes substantially to the world’s carbon footprint. Our aims are to review the current knowledge of Interventional Radiology (IR) waste generation and ways of reducing waste in practice, to quantify the environmental and financial impact of waste generated and address green initiatives to improve IR waste management.
Methods
A systematic literature search was conducted in July 2022 using the Medline and Embase literature databases. The scope of the search included the field of IR as well as operating theatre literature, where relevant to IR practice.
Results
One-hundred articles were reviewed and 68 studies met the inclusion criteria. Greening initiatives include reducing, reusing and recycling waste, as well as strict waste segregation. Interventional radiologists can engage with suppliers to reformulate procedure packs to minimize unnecessary items and packaging. Opened but unused equipment can be prevented if there is better communication within the team and increased staff awareness of wasted equipment cost. Incentives to use soon-to-expire equipment can be offered. Power consumption can be reduced by powering down operating room lights and workstations when not in use, changing to Light Emitting Diode (LED) and motion sensor lightings. Surgical hand wash can be replaced with alcohol-based hand rubs to reduce water usage. Common barriers to improving waste management include the lack of leadership, misconceptions regarding infectious risk, lack of data, concerns about increased workload, negative staff attitudes and resistance to change. Education remains a top priority to engage all staff in sustainable healthcare practices.
Conclusion
Interventional radiologists have a crucial role to play in improving healthcare sustainability. By implementing small, iterative changes to our practice, financial savings, greater efficiency and improved environmental sustainability can be achieved.
Collapse
|
15
|
Martinel V, Nourissat G, Barth J, Zipoli B, Bonnevialle N. The Hybridge Technique: A Combined Technique of Suture Bridge and Tension Band for an Arthroscopic Eco-Responsible Rotator Cuff Repair. Arthrosc Tech 2022; 11:e2337-e2345. [PMID: 36632402 PMCID: PMC9827004 DOI: 10.1016/j.eats.2022.08.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 08/22/2022] [Indexed: 11/19/2022] Open
Abstract
Arthroscopic rotator cuff repair is mainly based on 2 proven biomechanical concepts: suture bridge and tension band. This Technical Note describes the use of a combination of these 2 techniques to repair extensive lesions with only 3 anchors. Besides being less expensive, the use of a limited number of anchors is part of a global medicoeconomic and eco-responsible approach to our surgical activities.
Collapse
Affiliation(s)
- Vincent Martinel
- Groupe Orthopédie Ormeau Pyrénées, ELSAN - Polyclinique de l’Ormeau, Tarbes, France,Address correspondence to Vincent Martinel, M.D., Groupe Orthopédie Ormeau Pyrénées, ELSAN - Polyclinique de l’Ormeau, 28 Bvd du 8 Mai 1945, 65000 Tarbes, France.
| | | | - Johannes Barth
- Département de chirurgie orthopédique, Centre ostéoarticulaire des cèdres, Parc Sud Galaxie, Echirolles, Grenoble, France
| | - Bruno Zipoli
- Service orthopédie et traumatologie, centre hospitalier de Dax, Dax, France
| | - Nicolas Bonnevialle
- Département d’orthopédie traumatologie CHU de Toulouse, place du docteur Baylac, Hôpital Riquet, Toulouse, France,Green Shoulder Circle, Lourdes, France, France
| | | |
Collapse
|
16
|
Environmental Sustainability in the Orthopaedic Operating Room. J Am Acad Orthop Surg 2022; 30:1039-1045. [PMID: 36007200 DOI: 10.5435/jaaos-d-22-00247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 06/19/2022] [Indexed: 02/01/2023] Open
Abstract
Hotter global temperatures and increasingly variable climate patterns negatively affect human health, with a wide recognition that climate change is a major global health threat. Human activities, including those conducted in the orthopaedic operating room (OR), contribute to climate change by generating greenhouse gases that trap infrared radiation from the earth's surface. This review provides an overview of the environmental effect of the orthopaedic OR and efforts to address environmental sustainability in the OR. These concepts are presented with a particular focus on patient safety and cost savings because roll-out of these efforts must be conducted with a pragmatic and patient-centered focus. Orthopaedic surgeons have an opportunity to lead efforts to improve environmental sustainability in the OR and thus contribute to efforts to curb climate change.
Collapse
|
17
|
Bolten A, Kringos DS, Spijkerman IJB, Sperna Weiland NH. The carbon footprint of the operating room related to infection prevention measures: a scoping review. J Hosp Infect 2022; 128:64-73. [PMID: 35850380 DOI: 10.1016/j.jhin.2022.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Infection prevention measures are widely used in operating rooms (ORs). However, the extent to which they are at odds with ambitions to reduce the health sector's carbon footprint remains unclear. AIM To synthesize the evidence base for the carbon footprint of commonly used infection prevention measures in the OR, namely medical devices and instruments, surgical attire and air treatment systems. METHODS A scoping review of the international scientific literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search was performed in PubMed and Google Scholar. Articles published between 2010 and June 2021 on infection prevention measures, their impact on the health sector's carbon footprint, and risk for surgical site infections (SSIs) were included. FINDINGS Although hospitals strive to reduce their carbon footprint, many infection prevention measures result in increased emissions. Evidence suggests that the use of disposable items instead of reusable items generally increases the carbon footprint, depending on sources of electricity. Controversy exists regarding the correlation between air treatment systems, contamination and the incidence of SSIs. The literature indicates that new air treatment systems consume more energy and do not necessarily reduce SSIs compared with conventional systems. CONCLUSION Infection prevention measures in ORs can be at odds with sustainability. The use of new air treatment systems and disposable items generally leads to significant greenhouse gas emissions, and does not necessarily reduce the incidence of SSIs. Alternative infection prevention measures with less environmental impact are available. Implementation could be facilitated by embracing environmental impact as an additional dimension of quality of care, which should change current risk-based approaches for the prevention of SSIs.
Collapse
Affiliation(s)
- A Bolten
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - D S Kringos
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - I J B Spijkerman
- Department of Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - N H Sperna Weiland
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
| |
Collapse
|
18
|
Vorster FC, Diedericks BJS. Waste not, want not: the anaesthesiologist and the environment. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2022. [DOI: 10.36303/sajaa.2022.28.5.2801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- FC Vorster
- Department of Anaesthesiology, University of the Free State,
South Africa
| | - BJS Diedericks
- Department of Anaesthesiology, University of the Free State,
South Africa
| |
Collapse
|
19
|
Qin RX, Velin L, Yates EF, El Omrani O, McLeod E, Tudravu J, Samad L, Woodward A, McClain CD. Building sustainable and resilient surgical systems: A narrative review of opportunities to integrate climate change into national surgical planning in the Western Pacific region. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 22:100407. [PMID: 35243461 PMCID: PMC8881731 DOI: 10.1016/j.lanwpc.2022.100407] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Five billion people lack access to surgical care worldwide; climate change is the biggest threat to human health in the 21st century. This review studies how climate change could be integrated into national surgical planning in the Western Pacific region. We searched databases (PubMed, Web of Science, and Global Health) for articles on climate change and surgical care. Findings were categorised using the modified World Health Organisation Health System Building Blocks Framework. 220 out of 2577 records were included. Infrastructure: Operating theatres are highly resource-intensive. Their carbon footprint could be reduced by maximising equipment longevity, improving energy efficiency, and renewable energy use. Service delivery Tele-medicine, outreaches, and avoiding desflurane could reduce emissions. Robust surgical systems are required to adapt to the increasing burden of surgically treated diseases, such as injuries from natural disasters. Finance: Climate change adaptation funds could be mobilised for surgical system strengthening. Information systems: Sustainability should be a key performance indicator for surgical systems. Workforce: Surgical providers could change clinical, institutional, and societal practices. Governance: Planning in surgical care and climate change should be aligned. Climate change mitigation is essential in the regional surgical care scale-up; surgical system strengthening is also necessary for adaptation to climate change.
Collapse
|
20
|
Agbafe V, Berlin NL, Butler CE, Hawk E, Offodile Ii AC. Prescriptions for Mitigating Climate Change-Related Externalities in Cancer Care: A Surgeon's Perspective. J Clin Oncol 2022; 40:1976-1979. [PMID: 35333584 DOI: 10.1200/jco.21.02581] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Affiliation(s)
- Victor Agbafe
- University of Michigan Medical School, Ann Arbor, MI
| | | | - Charles E Butler
- Department of Plastic and Reconstructive Surgery, UT MD Anderson Cancer Center, Houston, TX
| | - Ernest Hawk
- Division of Cancer Prevention and Population Sciences, UT MD Anderson Cancer Center, Houston, TX
| | - Anaeze C Offodile Ii
- Department of Plastic and Reconstructive Surgery, UT MD Anderson Cancer Center, Houston, TX.,Baker Institute for Public Policy, Rice University, Houston, TX
| |
Collapse
|
21
|
Choi BJ, Chen CL. The Triple Bottom Line and Stabilization Wedges: A Framework for Perioperative Sustainability. Anesth Analg 2022; 134:475-485. [PMID: 35180164 PMCID: PMC9556165 DOI: 10.1213/ane.0000000000005890] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We present a narrative review of environmental sustainability aimed at perioperative clinicians. The review will familiarize readers with the triple bottom line framework, which aims to align the goals of delivering high-quality patient care, promoting environmental sustainability, and improving the financial position of health care organizations. We introduce the stabilization wedges model for climate change action adopted for the perioperative setting and discuss areas in which perioperative leaders can make sustainable choices. The goal of this review is to increase awareness among perioperative physicians of the environmental impacts of surgical and anesthetic care, promote engagement with sustainability efforts as a topic of professional concern for our specialty, and inspire new research in perioperative environmental sustainability.
Collapse
Affiliation(s)
| | - Catherine L. Chen
- Department of Anesthesiology and Perioperative Care, University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco
| |
Collapse
|