Sustainability
Optimising greener surgery: clinical considerations
Kate Woodhead highlights the need for every health board to enable their teams – and, in particular, their operating theatre teams – to examine their practice so they can reduce their carbon footprint. She discusses the recommendations ofThe Green Surgery Report and considers some of the potential barriers.
Climate change is having a devastating effect on our world already and is accepted as being one of the greatest challenges of the modern era. With floods, fires and frequent storms – not to mention the threat of vector borne diseases such as Lyme disease and dengue fever – we must take significant action to reduce or mitigate it as far as possible to reduce its increasing impact. It is generally accepted that the current use of resources globally is unsustainable for the health and wellbeing of future generations. Healthcare and surgical practice, in particular, comprises a significant proportion of global emissions estimated at 4.4%, when aviation only contributes 2.5%.1
Operating theatres are the
greatest users of resources in each hospital and therefore should have the greatest opportunity to reduce emissions and aid the target towards Net Zero by 2040, for the direct emissions that the NHS controls and a wider target for indirect emissions by 2045. This aim to reduce the carbon footprint of
the NHS is now law. It is not just a ‘nice to have’ but now a statutory requirement embedded into legislation in the Health and Care Act 2022. The report Delivering a Net Zero National Health Service is now issued as guidance.2 The provision of high-quality surgical
care and patient safety must be maintained, while reducing the carbon footprint of each surgery, in order to reduce the high cost to the environment. Surgical teams should devise activities for their theatres with all professions signed up to the strategy and needing leadership from within the hospital at board level as well. A typical operation is estimated to create 150-170 kg of CO2
driving 450 miles in an average petrol car.3
Surgical care pathways The wider impact of surgery and its activities on the hospitals’ carbon footprint can also be affected by streamlining surgical care pathways.4
Identifying steps in the surgical pathway that do not add value to the process equivalent, the same as
or to the patient are a good place to start the review prior to applying sustainability criteria to the process. Many hospitals undertook this years ago, examining whether patients can be moved to day surgery, thereby freeing beds for more complex surgery. During COVID-19, many outpatient appointments were undertaken using telemedicine which patients like, saving them travelling and the consequent emissions. This could be increased across the elective surgical preparation process and has been used by many Trusts seeking to reduce their footprint. However, this adds an extra burden on primary care as all the pre-surgery tests on bloods and X-rays, for example, will need to be undertaken via the GP. Telehealth also disenfranchises some elderly patients and those who have no access to the necessary digital services, as well as some disabled people with sensory impairment, and, for these reasons, it needs to be carefully implemented with other options available. One of the other activities that has evidence- based benefits for the surgical patient, and can lead to ‘slimmer’ patient care pathways, is prehabilitation. It comprises of multidisciplinary healthcare interventions, which include exercise, nutritional optimisation and psychological preparation. These aim to reduce the metabolic shock of surgery, shorten the recovery time, reduce complications and improve the quality of post operative recovery.5
In addition, advice
may be given on smoking cessation, alcohol moderation optimising weight and nutrition, in order for the patient to get the best possible outcome of their surgery. During the course of preparing the patient for
surgery, careful assessment of what necessary tests and investigations are required by the surgical team should be undertaken to optimise surgery for the patient. Many organisations have a raft of routine tests to which they subject every patient to. Many of these are unnecessary
July 2024 I
www.clinicalservicesjournal.com 13
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