The carbon footprint of cataract surgery

Morris, Daniel S.; Wright, Tom; Somner, John; Connor, Andrew

doi:10.1038/eye.2013.9

Cited by 149 publications

(176 citation statements)

References 17 publications

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“…Comparison of greenhouse gas emissions for phacoemulsification in the U.K. and at Aravind based on economic subsectors, modified from Morris et al, 11 to account for different study boundaries (* = Aravind’s laundry services are included in the Procurement - Water category; CO 2 -e = carbon dioxide-equivalent; GHG = greenhouse gas).…”

Section: Figurementioning

confidence: 99%

“…10 Cataract surgery in the U.K. emits 180 kilograms (kg) of carbon dioxide (CO 2 )-equivalents per eye, with more than one half of those emissions originating from the procurement of largely disposable medical equipment. 11 Globally, the cost of cataract surgery frequently impedes access for those who need it most. 12,13 In its mission to eradicate unnecessary blindness, the Aravind Eye Care System, in the southern Indian state of Tamil Nadu, has developed an innovative and effective model of care centered on time efficiency and resource efficiency.…”

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confidence: 99%

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Cataract surgery and environmental sustainability: Waste and lifecycle assessment of phacoemulsification at a private healthcare facility

Thiel¹,

Schehlein²,

Ravilla³

et al. 2017

Journal of Cataract and Refractive Surgery

162

143

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Purpose To measure the waste generation and lifecycle environmental emissions from cataract surgery via phacoemulsification in a recognized resource-efficient setting. Setting Two tertiary care centers of the Aravind Eye Care System in southern India. Design Observational case series. Methods Manual waste audits, purchasing data, and interviews with Aravind staff were used in a hybrid environmental lifecycle assessment framework to quantify the environmental emissions associated with cataract surgery. Kilograms of solid waste generated and midpoint emissions in a variety of impact categories (eg, kilograms of carbon dioxide equivalents). Results Aravind generates 250 grams of waste per phacoemulsification and nearly 6 kilograms of carbon dioxide-equivalents in greenhouse gases. This is approximately 5% of the United Kingdom’s phaco carbon footprint with comparable outcomes. A majority of Aravind’s lifecycle environmental emissions occur in the sterilization process of reusable instruments because their surgical system uses largely reusable instruments and materials. Electricity use in the operating room and the Central Sterile Services Department (CSSD) accounts for 10% to 25% of most environmental emissions. Conclusions Results show that surgical systems in most developed countries and, in particular their use of materials, are unsustainable. Ophthalmologists and other medical specialists can reduce material use and emissions in medical procedures using the system described here.

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Section: Figurementioning

confidence: 99%

mentioning

confidence: 99%

Cataract surgery and environmental sustainability: Waste and lifecycle assessment of phacoemulsification at a private healthcare facility

Thiel¹,

Schehlein²,

Ravilla³

et al. 2017

Journal of Cataract and Refractive Surgery

162

143

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“…These sources estimated the CO 2 intensity of cataract surgery (24) and renal services (25) from estimates of their total CO 2 footprint and costs derived from the literature (see Table 1 and Supplementary Appendix 1). In the scenario analysis, these CO 2 intensity estimates were used to estimate the CO 2 impact of T2DM-related eye and renal complications.…”

Section: Environmental Inputsmentioning

confidence: 99%

Incorporating Environmental Outcomes Into a Health Economic Model

Marsh¹,

Ganz

Nørtoft

et al. 2016

Int J Technol Assess Health Care

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Objectives: Traditional economic evaluations for most health technology assessments (HTAs) have previously not included environmental outcomes. With the growing interest in reducing the environmental impact of human activities, the need to consider how to include environmental outcomes into HTAs has increased. We present a simple method of doing so. Methods: We adapted an existing clinical-economic model to include environmental outcomes (carbon dioxide [CO 2 ] emissions) to predict the consequences of adding insulin to an oral antidiabetic (OAD) regimen for patients with type 2 diabetes mellitus (T2DM) over 30 years, from the United Kingdom payer perspective. Epidemiological, efficacy, healthcare costs, utility, and carbon emissions data were derived from published literature. A scenario analysis was performed to explore the impact of parameter uncertainty.Results: The addition of insulin to an OAD regimen increases costs by 2,668 British pounds per patient and is associated with 0.36 additional quality-adjusted life-years per patient. The insulin-OAD combination regimen generates more treatment and disease management-related CO 2 emissions per patient (1,686 kg) than the OAD-only regimen (310 kg), but generates fewer emissions associated with treating complications (3,019 kg versus 3,337 kg). Overall, adding insulin to OAD therapy generates an extra 1,057 kg of CO 2 emissions per patient over 30 years. Conclusions: The model offers a simple approach for incorporating environmental outcomes into health economic analyses, to support a decision-maker's objective of reducing the environmental impact of health care. Further work is required to improve the accuracy of the approach; in particular, the generation of resource-specific environmental impacts.

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“…LCAs exist for whole operations8–11 and individual devices,12–15 but LCAs of drugs are rarely publicly available16 due primarily to the proprietary nature of drug synthesis. Some published ‘in-house’ (commercial in confidence) LCAs, however, have been performed by drug companies 17.…”

Section: Introductionmentioning

confidence: 99%

The Environmental footprint of morphine: a life cycle assessment from opium poppy farming to the packaged drug

McAlister

Neff³

et al. 2016

BMJ Open

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ObjectiveTo examine the environmental life cycle from poppy farming through to production of 100 mg in 100 mL of intravenous morphine (standard infusion bag).Design‘Cradle-to-grave’ process-based life cycle assessment (observational).SettingsAustralian opium poppy farms, and facilities for pelletising, manufacturing morphine, and sterilising and packaging bags of morphine.Main outcome measuresThe environmental effects (eg, CO2 equivalent (‘CO2 e’) emissions and water use) of producing 100 mg of morphine. All aspects of morphine production from poppy farming, pelletising, bulk morphine manufacture through to final formulation. Industry-sourced and inventory-sourced databases were used for most inputs.ResultsMorphine sulfate (100 mg in 100 mL) had a climate change effect of 204 g CO2 e (95% CI 189 to 280 g CO2 e), approximating the CO2 e emissions of driving an average car 1 km. Water use was 7.8 L (95% CI 6.7– to 9.0 L), primarily stemming from farming (6.7 L). All other environmental effects were minor and several orders of magnitude less than CO2 e emissions and water use. Almost 90% of CO2 e emissions occurred during the final stages of 100 mg of morphine manufacture. Morphine's packaging contributed 95 g CO2 e, which accounted for 46% of the total CO2 e (95% CI 82 to 155 g CO2 e). Mixing, filling and sterilisation of 100 mg morphine bags added a further 86 g CO2 e, which accounted for 42% (95% CI 80 to 92 g CO2 e). Poppy farming (6 g CO2 e, 3%), pelletising and manufacturing (18 g CO2 e, 9%) made smaller contributions to CO2 emissions.ConclusionsThe environmental effects of growing opium poppies and manufacturing bulk morphine were small. The final stages of morphine production, particularly sterilisation and packaging, contributed to almost 90% of morphine's carbon footprint. Focused measures to improve the energy efficiency and sources for drug sterilisation and packaging could be explored as these are relevant to all drugs. Comparisons of the environmental effects of the production of other drugs and between oral and intravenous preparations are required.

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The carbon footprint of cataract surgery

Cited by 149 publications

References 17 publications

Cataract surgery and environmental sustainability: Waste and lifecycle assessment of phacoemulsification at a private healthcare facility

Cataract surgery and environmental sustainability: Waste and lifecycle assessment of phacoemulsification at a private healthcare facility

Incorporating Environmental Outcomes Into a Health Economic Model

The Environmental footprint of morphine: a life cycle assessment from opium poppy farming to the packaged drug

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