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Downes A, Healy DG. Expiry dates in surgical equipment: What are the options? Surgeon 2024:S1479-666X(24)00030-1. [PMID: 38584040 DOI: 10.1016/j.surge.2024.03.003] [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: 01/14/2024] [Revised: 03/23/2024] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Hospitals and the healthcare system contribute significantly to global warming, due to the energy use, water use and waste produce going directly to landfill. The operating theatre environment contributes to 70% of all hospital waste, and a proportion of this is due to unused surgical supplies, such as those stocked but never used as they go past their use-by date. AIM To evaluate how use-by dates are identified and assigned to surgical equipment, and if there are opportunities to re-use, or re-sterilise this equipment in order to reduce waste from the operating theatre environment. RESULTS Use-by dates are assigned to ensure sterility and longevity of the device, and are assigned based on risk analysis, retrospective and prospective assessment. Incineration is the mainstay of disposal of unused medical devices, but there are alternative options such as re-processing in specific circumstances. CONCLUSION A large volume of hospital waste is due to operating theatres, and there is movement towards developing more sustainable methods of dealing with expired surgical equipment. This is however in the early stages, with further research required to confirm if these methods will be safe for patients, and beneficial to the environment.
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Affiliation(s)
- Amber Downes
- Department of Cardiothoracic Surgery, Cork University Hospital, Ireland.
| | - David G Healy
- Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Ireland
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Dargent J. Reducing greenhouse gas emissions in a bariatric surgical unit is a complex but feasible project. Sci Rep 2024; 14:1252. [PMID: 38218989 PMCID: PMC10787753 DOI: 10.1038/s41598-024-51441-9] [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: 05/10/2023] [Accepted: 01/04/2024] [Indexed: 01/15/2024] Open
Abstract
Obesity is a growing issue worldwide, whose causes and consequences are linked to the environment and which therefore has a high carbon footprint. On the other hand, obesity surgery, along with other procedures in surgical suites, entails environmental consequences and responsibilities. We conducted a prospective comparative study on two groups of bariatric interventions (N = 59 and 56, respectively) during two consecutive periods of time (Oct 2021-March 2022), first without and then with specific measures aimed at reducing greenhouse gas emissions related to bariatric procedures by approximately 18%. These measures included recycling of disposable surgical equipment, minimizing its use, and curbing anesthetic gas emissions. Further and continuous efforts/incentives are warranted, including reframing the surgical strategies. Instead of comparing measurements, which is difficult at the present time, we suggest defining an ECO-SCORE in operating rooms, among other healthcare facilities.
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Affiliation(s)
- Jerome Dargent
- Polyclinique de Rillieux, 65 Rue des Contamines, 69140, Rillieux-la-Pape, France.
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Qin R, Alayande B, Okolo I, Khanyola J, Jumbam DT, Koea J, Boatin AA, Lugobe HM, Bump J. Colonisation and its aftermath: reimagining global surgery. BMJ Glob Health 2024; 9:e014173. [PMID: 38176746 PMCID: PMC10773343 DOI: 10.1136/bmjgh-2023-014173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Accepted: 11/24/2023] [Indexed: 01/06/2024] Open
Abstract
Coloniality in global health manifests as systemic inequalities, not based on merit, that benefit one group at the expense of another. Global surgery seeks to advance equity by inserting surgery into the global health agenda; however, it inherits the biases in global health. As a diverse group of global surgery practitioners, we aimed to examine inequities in global surgery. Using a structured, iterative, group Delphi consensus-building process drawing on the literature and our lived experiences, we identified five categories of non-merit inequalities in global surgery. These include Western epistemology, geographies of inequity, unequal participation, resource extraction, and asymmetric power and control. We observed that global surgery is dominated by Western biomedicine, characterised by the lack of interprofessional and interspecialty collaboration, incorporation of Indigenous medical systems, and social, cultural, and environmental contexts. Global surgery is Western-centric and exclusive, with a unidirectional flow of personnel from the Global North to the Global South. There is unequal participation by location (Global South), gender (female), specialty (obstetrics and anaesthesia) and profession ('non-specialists', non-clinicians, patients and communities). Benefits, such as funding, authorship and education, mostly flow towards the Global North. Institutions in the Global North have disproportionate control over priority setting, knowledge production, funding and standards creation. This naturalises inequities and masks upstream resource extraction. Guided by these five categories, we concluded that shifting global surgery towards equity entails building inclusive, pluralist, polycentric models of surgical care by providers who represent the community, with resource controlled and governance driven by communities in each setting.
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Affiliation(s)
- Rennie Qin
- Department of Epidemiology and Biostatistics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
- Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Barnabas Alayande
- Center for Equity in Global Surgery, University of Global Health Equity, Kigali, Gasabo, Rwanda
- Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Isioma Okolo
- Department of Obstetrics and Gynaecology, NHS Slothian, Edinburgh, UK
| | - Judy Khanyola
- Center for Nursing and Midwifery, University of Global Health Equity, Kigali, Gasabo, Rwanda
| | - Desmond Tanko Jumbam
- Department of Health Policy and Advocacy, Operation Smile, Virginia Beach, Virginia, USA
| | - Jonathan Koea
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Adeline A Boatin
- Department of Obstetrics & Gynecology and Center for Global Health, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Henry Mark Lugobe
- Department of Obstetrics and Gynecology, Mbarara University of Science and Technology Faculty of Medicine, Mbarara, Uganda
| | - Jesse Bump
- Global Health and Population, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA
- Bergen Center for Ethics and Priority Setting, University of Bergen, Bergen, Norway
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Umo I, Pangiau M, Kukiti J, Ona A, Tepoka S, James K, Ikasa R. Estimating the carbon emissions from a resource-limited surgical suite in Papua New Guinea: The climate change potential. DIALOGUES IN HEALTH 2023; 2:100108. [PMID: 38515480 PMCID: PMC10953991 DOI: 10.1016/j.dialog.2023.100108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 03/23/2024]
Abstract
Introduction The upscale of surgical service delivery in low to middle income countries will increase health sector greenhouse gas emissions globally. Understanding surgical greenhouse gas emissions from surgical suite activities can direct decarbonization strategies and achieve local, and global climate change objectives. Material and methods A prospective surgical suite carbon foot print study was conducted at the Alotau Provincial Hospital from the 28th March 2022 to the 28th of May 2022. Results The total carbon emission for the surgical suite in APH over the study period was 2,665.8 kgCO2e. The average carbon emission per surgical case within the boundary of the surgical suite was 8.4 kgCO2e. Scope one emissions (anaesthetic gases) accounted for 44.7% (1171.3 kgCO2e) of all carbon emissions. Conclusion If no action is taken, carbon emissions in the western pacific region will continue to increase from surgical suites. Therefore, proactive efforts to reduce greenhouse gas emissions must be prioritized.
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Affiliation(s)
- Ian Umo
- Surgery Department, Alotau Provincial Hospital, Milne Bay Provincial Health Authority, Papua New Guinea
| | - Margaret Pangiau
- Anaesthesia Department, Alotau Provincial Hospital, Milne Bay Provincial Health Authority, Papua New Guinea
| | - John Kukiti
- Obstetrics and Gynecology Department, Alotau Provincial Hospital, Milne Bay Provincial Health Authority, Papua New Guinea
| | - Amos Ona
- Operating Theatre Department, Alotau Provincial Hospital, Milne Bay Provincial Health Authority, Papua New Guinea
| | - Sipie Tepoka
- Operating Theatre Department, Alotau Provincial Hospital, Milne Bay Provincial Health Authority, Papua New Guinea
| | - Kennedy James
- Surgery Department, Alotau Provincial Hospital, Milne Bay Provincial Health Authority, Papua New Guinea
| | - Rodger Ikasa
- Surgery Department, Alotau Provincial Hospital, Milne Bay Provincial Health Authority, Papua New Guinea
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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 2023. [PMID: 37985608 DOI: 10.1111/ans.18770] [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: 07/05/2023] [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.
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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
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Qin R, Woodward A. Towards sustainable surgical care systems: a broader framing. ANZ J Surg 2023; 93:2550-2551. [PMID: 38011592 DOI: 10.1111/ans.18682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 11/29/2023]
Affiliation(s)
- Rennie Qin
- Department of General Surgery, Te Whatu Ora Whanganui, Whanganui, New Zealand
- Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
| | - Alistair Woodward
- Department of Epidemiology and Biostatistics, University of Auckland, Auckland, New Zealand
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Thiel CL, Mehta N, Sejo CS, Qureshi L, Moyer M, Valentino V, Saleh J. Telemedicine and the environment: life cycle environmental emissions from in-person and virtual clinic visits. NPJ Digit Med 2023; 6:87. [PMID: 37160996 PMCID: PMC10169113 DOI: 10.1038/s41746-023-00818-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/04/2023] [Indexed: 05/11/2023] Open
Abstract
Concern over climate change is growing in the healthcare space, and telemedicine has been rapidly expanding since the start of the COVID19 pandemic. Understanding the various sources of environmental emissions from clinic visits-both virtual and in-person-will help create a more sustainable healthcare system. This study uses a Life Cycle Assessment with retrospective clinical data from Stanford Health Care (SHC) in 2019-2021 to determine the environmental emissions associated with in-person and virtual clinic visits. SHC saw 13% increase in clinic visits, but due to the rise in telemedicine services, the Greenhouse Gas emissions (GHGs) from these visits decreased 36% between 2019 and 2021. Telemedicine (phone and video appointments) helped SHC avoid approximately 17,000 metric tons of GHGs in 2021. Some departments, such as psychiatry and cancer achieved greater GHG reductions, as they were able to perform more virtual visits. Telemedicine is an important component for the reduction of GHGs in healthcare systems; however, telemedicine cannot replace every clinic visit and proper triaging and tracking systems should be in place to avoid duplicative care.
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Affiliation(s)
- Cassandra L Thiel
- NYU Langone Health, Departments of Population Health and Ophthalmology, New York, NY, USA.
| | - Natasha Mehta
- Stanford Department of Internal Medicine, Stanford, CA, USA
| | - Cory Sean Sejo
- Stanford Department of Internal Medicine, Stanford, CA, USA
| | - Lubna Qureshi
- Stanford Health Care, Digital Health, Stanford, CA, USA
| | - Meagan Moyer
- Stanford Health Care, Digital Health, Stanford, CA, USA
| | | | - Jason Saleh
- Palo Alto Veterans Affairs & Stanford University, Stanford, CA, USA
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[Position paper and recommendations for action for ecologically sustainable ophthalmology : Statement of the German Society of Ophthalmology (DOG) and the German Professional Association of Ophthalmologists (BVA)]. DIE OPHTHALMOLOGIE 2023; 120:52-68. [PMID: 36625883 PMCID: PMC9838365 DOI: 10.1007/s00347-022-01792-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 06/17/2023]
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Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries. Lancet 2022; 400:1607-1617. [PMID: 36328042 PMCID: PMC9621702 DOI: 10.1016/s0140-6736(22)01846-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/18/2022] [Accepted: 09/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. METHODS First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. FINDINGS In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45·6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84·5 (95% CI 84·1-84·9), which varied between HIC (88·5 [89·0-88·0]), MIC (81·8 [82·5-81·1]), and LIC (66·8 [64·9-68·7]) settings. In the third phase, 1217 (74·6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51·4%) were from HIC, 538 (44·2%) from MIC, and 54 (4·4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3·6% (95% CI 3·0-4·1; p<0·0001) increase in SVR. This was consistent in HIC (4·8% [4·1-5·5]; p<0·0001), MIC (2·8 [2·0-3·7]; p<0·0001), and LIC (3·8 [1·3-6·7%]; p<0·0001) settings. INTERPRETATION The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs. FUNDING National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, NIHR Academy, Association of Coloproctology of Great Britain and Ireland, Bowel Research UK, British Association of Surgical Oncology, British Gynaecological Cancer Society, and Medtronic.
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Affiliation(s)
- L Brunaud
- University of Lorraine, CHRU Nancy, Hospital Brabois Adultes, Department of Gastrointestinal, Visceral, and Metabolic Surgery (CVMC), INSERM U1256, "Nutrition, Genetics, Environmental Risks," Faculty of Medicine, Nancy, France
| | - K Slim
- University Hospital, CHU Clermont-Ferrand, Department of Digestive Surgery, Francophone Group for Enhanced Recovery After Surgery (GRACE), place Lucie-Aubrac, 63003 Clermont-Ferrand, France.
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