The carbon footprint of products used in five common surgical operations: identifying contributing products and processes

Author:

Rizan Chantelle1ORCID,Lillywhite Robert2,Reed Malcom1ORCID,Bhutta Mahmood F13

Affiliation:

1. Brighton and Sussex Medical School, Royal Sussex County Hospital, Brighton, BN25BE, UK

2. School of Life Sciences, University of Warwick, Coventry, CV4 7AL, UK

3. ENT Department, University Hospitals Sussex NHS Foundation Trust, Brighton, BN2 5BE, UK

Abstract

Objectives Mitigating carbon footprint of products used in resource-intensive areas such as surgical operating rooms will be important in achieving net zero carbon healthcare. The aim of this study was to evaluate the carbon footprint of products used within five common operations, and to identify the biggest contributors (hotspots). Design A predominantly process-based carbon footprint analysis was conducted for products used in the five highest volume surgical operations performed in the National Health System in England. Setting The carbon footprint inventory was based on direct observation of 6–10 operations/type, conducted across three sites within one NHS Foundation Trust in England. Participants Patients undergoing primary elective carpal tunnel decompression, inguinal hernia repair, knee arthroplasty, laparoscopic cholecystectomy, tonsillectomy (March 2019 – January 2020). Main outcome measures We determined the carbon footprint of the products used in each of the five operations, alongside greatest contributors through analysis of individual products and of underpinning processes. Results The mean average carbon footprint of products used for carpal tunnel decompression was 12.0 kg CO2e (carbon dioxide equivalents); 11.7 kg CO2e for inguinal hernia repair; 85.5 kg CO2e for knee arthroplasty; 20.3 kg CO2e for laparoscopic cholecystectomy; and 7.5 kg CO2e for tonsillectomy. Across the five operations, 23% of product types were responsible for ≥80% of the operation carbon footprint. Products with greatest carbon contribution for each operation type were the single-use hand drape (carpal tunnel decompression), single-use surgical gown (inguinal hernia repair), bone cement mix (knee arthroplasty), single-use clip applier (laparoscopic cholecystectomy) and single-use table drape (tonsillectomy). Mean average contribution from production of single-use items was 54%, decontamination of reusables 20%, waste disposal of single-use items 8%, production of packaging for single-use items 6% and linen laundering 6%. Conclusions Change in practice and policy should be targeted towards those products making greatest contribution, and should include reducing single-use items and switching to reusables, alongside optimising processes for decontamination and waste disposal, modelled to reduce carbon footprint of these operations by 23%–42%.

Funder

Royal College of Surgeons of England

Health Education England

Publisher

SAGE Publications

Subject

General Medicine

Reference46 articles.

1. Karliner J, Slotterback S, Boyd R, Ashby B, Steele K. Health care's climate footprint, Climate-smart health care series green paper number one. Health Care without Harm, September 2019. See https://noharm-global.org/sites/default/files/documents-files/5961/HealthCaresClimateFootprint_092319.pdf (last checked 9 August 2022).

2. Health care's response to climate change: a carbon footprint assessment of the NHS in England

3. World Health Organization. COP26 Health Programme Country Commitments. World Health Organization, 2021. See www.who.int/initiatives/cop26-health-programme/country-commitments (last checked 9 August 2022).

4. The Carbon Footprint of Surgical Operations

5. Operating in a Climate Crisis: A State-of-the-Science Review of Life Cycle Assessment within Surgical and Anesthetic Care

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