How can we address the ever-pressing need to ‘green up’ surgical practice in the National Health Service?

Abstract

Clinical practice has inadvertently changed after the COVID-19 pandemic and currently the need to provide sustainable surgical services is more pressing than ever. The National Health Service has committed to a long-term efficient plan to reduce carbon footprint but there is no detailed plan for surgical practice, the domain that contributes the most to hospital-derived pollution. A series of consecutive steps and measures ought to be taken, starting from a hybrid approach quantifying surgically attributed carbon footprint. Then, a variety of suggested measures can be widely discussed and accordingly applied on a wider or more local level. Appropriate training should always precede implementing new practices to ensure that staff is familiar with these. These measures cover a broad range and should be arranged on a patient-centred basis from preoperative preconditioning to an effective follow-up. The need for more intense research and implementation of enhanced recovery protocols is widely discussed. Also, the necessity of green research and reinvestment of materials and resources is highlighted. A change of philosophy from a cradle-to-grave approach to a repurposing approach is suggested. We are confident that a new era is dawning in surgical practice and teamwork is the key for providing greener surgical services.

A long road ahead. A German national survey study on awareness and willingness of surgeons towards the carbon footprint of modern surgical procedures

“…Section B was captured general personal opinions towards climate change, carbon footprints and CO2 consumption in daily life and at the workplace. In section C, questions were designed to address specific aspects in the daily routine of a surgeon, such as the use of specific instruments and reusability, information on product life cycle assessments and packaging [ 12 ]. In section D, we aimed to elucidate personal perception of existing barriers towards more CO2 neutral alternatives.…”

Reducing the Environmental Impact of Clinical Care

“…Operating Rooms and Surgical Services Surgical services are currently the most resource-intensive areas of clinical care, 18 and operating rooms represent 1 of the largest users of medical supplies and producers of medical waste� 19 Waste in the operating room largely consists of disposable products, such as gowns, gloves, surgical instruments and equipment, implants, and packaging. 20 Further, the use of anesthetic gases (described in the next section) is a major contributor to the carbon footprint of operating rooms and surgical services� One way to reduce waste from operating rooms is to reduce the amount of surgical supplies that are prepared for surgical procedures but are not used and are therefore discarded� There are multiple ways to reformulate and streamline prepackaged kits and surgical packs to reduce waste; this can include preparing sets with the minimum required instruments for specific procedures, or removing items that are regularly thrown out and packaging them separately� [20][21][22][23][24][25] Prelabelled surgical trays can help reduce their unnecessary use, and for those surgical instruments that are reused and sterilized, reducing unnecessary use can avoid redundant sterilization and can increase their lifespan� 24…”

“…Currently, activities to make clinical care environmentally sustainable are largely pursued and developed based on opportunities identified by champions and front-line staff, which are reinforced by facility or organizational policies� What is certain is that this is an area where momentum continues to build as health care acts to mitigate climate change� Productive dialogues across stakeholders involved in clinical interventions and devices can point to and advance shared goals, and deliver cost-effective, clinically effective, and environmentally sustainable health care. This includes opportunities -like those identified in the earlier section on rethinking and research -to rethink how and where clinical care is delivered, and rethink the design of medical devices to become more environmentally sustainable� While the initiatives here are those found in the clinical literature, drawing on the expertise of environmental scientists, sustainability management professionals, and others is likely to provide greater insight into and opportunities for environmentally sustainable health care� As the evidence base around the environmental footprint of clinical interventions and devices grows, there is an opportunity for health technology assessment agencies and health care decision-makers to adopt clinical interventions and devices based on patient, clinical, economic, ethics, and social values, as well as environmental considerations� 24 Increased investment and support from multidisciplinary research communities to assess the environmental impact of clinical care will help support future decision-making to meet these goals�…”

Workforce, workforce, workforce: a wellbeing crisis without resolution

“…It’s simple logic that neglecting the health and wellbeing of staff affects patient care. When there are pressures everywhere, from an urgent need to “green up” surgical practice 3 to using health data to transform outpatient care for people with long-term conditions, 4 the success of these worthy initiatives hangs by the delicate thread of staff wellbeing. Just as systematic reviews are only as persuasive as the research they rely upon, 5 critical care decision making driven by machine learning is only as good as the people interpreting the data, 6 or an effective pandemic strategy depends on understanding what endemicity really is, 7 staff are only as effective as their wellbeing allows.…”