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Fuschi A, Pastore AL, Al Salhi Y, Martoccia A, De Nunzio C, Tema G, Rera OA, Carbone F, Asimakopoulos AD, Sequi MB, Valenzi FM, Suraci PP, Scalzo S, Del Giudice F, Nardecchia S, Bozzini G, Corsini A, Sciarra A, Carbone A. The impact of radical prostatectomy on global climate: a prospective multicentre study comparing laparoscopic versus robotic surgery. Prostate Cancer Prostatic Dis 2024; 27:272-278. [PMID: 37085603 DOI: 10.1038/s41391-023-00672-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/26/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023]
Abstract
BACKGROUND More than 4% of the global greenhouse gas emissions are generated by healthcare system. Focusing on the environmental impact of minimally invasive surgery, we assessed and compared the CO2 emissions between Robot-assisted (RALP) and Laparoscopic Radical Prostatectomy (LRP). METHODS In patients prospectively enrolled, we evaluated the age, surgical and anesthesiologic time, postoperative intensive care unit and hospital stay, blood transfusion, pre- and postoperative hemoglobin and Gleason score, open conversion need, and complications (Clavien-Dindo classification). We assessed the life cycle to estimate the energy consumption for surgical procedures and hospital stays. We reported the materials, CO2 produced, and fluid quantity infused and dispersed. Disposable and reusable materials and instruments were weighed and divided into metal, plastic, and composite fibers. The CO2 consumption for disposal and decontamination was also evaluated. RESULTS Of the 223 patients investigated, 119 and 104 patients underwent RALP and LRP, respectively. The two groups were comparable as regards age and preoperative Gleason score. The laparoscopic and robotic instruments weighed 1733 g and 1737 g, respectively. The CO2 emissions due to instrumentation were higher in the laparoscopic group, with the majority coming from plastic and composite fiber components. The CO2 emissions for metal components were higher in the robotic group. The robot functioned at 3.5 kW/h, producing 4 kg/h of CO2. The laparoscopic column operated at 600 W/h, emitting ~1 kg/h of CO2. The operating room operated at 3,0 kW/h. The operating time was longer in the laparoscopic group, resulting in higher CO2 emissions. CO2 emissions from hospital room energy consumption were lower in the robot-assisted group. The total CO2 emissions were ~47 kg and ~60 kg per procedure in the robot-assisted and laparoscopic groups, respectively. CONCLUSIONS RALP generates substantially less CO2 than LRP owing to the use of more reusable surgical supplies, shorter operative time and hospital stay.
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Affiliation(s)
- Andrea Fuschi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Antonio Luigi Pastore
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy.
| | - Yazan Al Salhi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Alessia Martoccia
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Giorgia Tema
- Department of Urology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Onofrio Antonio Rera
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Flavia Carbone
- Uroresearch, Non-profit Association for Research in Urology, Latina, Italy
| | | | - Manfredi Bruno Sequi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Fabio Maria Valenzi
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Paolo Pietro Suraci
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Silvio Scalzo
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
| | - Francesco Del Giudice
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Stefano Nardecchia
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, Rome, Italy
| | - Giorgio Bozzini
- Department of Urology, ASST Lariana-Sant'Anna Hospital, Como, Italy
| | - Alessandro Corsini
- Department of Mechanical and Aerospace Engineering, Sapienza University of Rome, Rome, Italy
| | - Alessandro Sciarra
- Department of Urology, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
| | - Antonio Carbone
- Faculty of Pharmacy and Medicine, Department of Medico-Surgical Sciences and Biotechnologies, Urology Unit, Sapienza University of Rome, Latina, Italy
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Jong JLZ, Tan JHY, Wang H. Sustained practice of immediate sequential bilateral cataract surgery (ISBCS) in a post-COVID era. Eur J Ophthalmol 2024:11206721241255762. [PMID: 38803197 DOI: 10.1177/11206721241255762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2024]
Affiliation(s)
- Joel L Z Jong
- Medical School, Academic Unit of Medical Education, University of Sheffield, Sheffield, UK
- Ophthalmology Department, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Trust, Sheffield, UK
| | - Jennifer H Y Tan
- Ophthalmology Department, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Trust, Sheffield, UK
| | - Haoyu Wang
- Ophthalmology Department, Royal Hallamshire Hospital, Sheffield Teaching Hospital NHS Trust, Sheffield, UK
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Maheshwari K, Epanomeritakis IE, Hills S, Hindocha S. Carbon footprint of a laser unit: a study of two centres in the UK. Lasers Med Sci 2024; 39:134. [PMID: 38771416 DOI: 10.1007/s10103-024-04081-4] [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: 02/08/2024] [Accepted: 05/12/2024] [Indexed: 05/22/2024]
Abstract
PURPOSE Climate change has serious consequences for our wellbeing. Healthcare systems themselves contribute significantly to our total carbon footprint, of which emissions from surgical practice are a major component. The primary sources of emissions identified are anaesthetic gases, disposal of single-use equipment, energy usage, and travel to and from clinical areas. We sought to quantify the waste generated by laser surgery which, to our knowledge, has not been previously reported. METHODS The carbon footprint of two laser centres operating within the United Kingdom were measured. The internationally recognised Greenhouse Gas Protocol was used as a guiding framework to classify sources of waste and conversion factors issued by the UK government were used to quantify emissions. RESULTS The total carbon footprints per day at each unit were 299.181 carbon dioxide equivalents (kgCo2eq) and 121.512 kgCO2eq, respectively. We found the carbon footprint of individual laser treatments to be approximately 15 kgCO2eq per procedure. The biggest overall contributor to the carbon footprint was found to be the emissions generated from staff, patient and visitor travel. This was followed by electricity usage, and indirect emissions from physical waste and laundry. CONCLUSIONS The carbon footprint of laser procedures was considerably less than the average surgical operation in the UK. This initial study measures the carbon footprint of a laser center in a clinical setting and allows us to identify where improvements can be made to eventually achieve a net carbon zero health care system.
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Affiliation(s)
- Kavish Maheshwari
- Department of Plastic Surgery, Bedford Hospital NHS trust, Bedford, UK.
| | | | | | - Sandip Hindocha
- Department of Plastic Surgery, Bedford Hospital NHS trust, Bedford, UK
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Barber B, Rainham DG, Tyedmers P, Vandertuin T, Ritcey G, Christie SD. Taking action towards climate-resilient, low-carbon, health systems: Perspectives from Canadian health leaders and healthcare professionals. Healthc Manage Forum 2024:8404704241252032. [PMID: 38739689 DOI: 10.1177/08404704241252032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Climate change poses significant public health and health system challenges including increased demand for health services due to chronic and acute health impacts from vector-borne diseases, heat-related illness, and injury from severe weather. As climate change worsens, so do its effects on health systems such as increasing severity of weather extremes causing damage to healthcare infrastructure and interference with supply chains. Ironically, health sectors globally are significant contributors to climate change, generating an estimated 5% of global emissions. Achieving "net zero" health systems require large-scale change with shared decision-making to coordinate a pan-Canadian approach to creating climate-resilient and low-carbon healthcare. In this article, we discuss healthcare professionals' and health leaders' perceptions of responsibility for practicing and advocating for climate-resilient and low-carbon healthcare in Canada.
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Malcolm J, Dodd A, Shaikh M, Cassels-Brown A, Buchan JC. Reducing the carbon footprint of cataract surgery: co-creating solutions with a departmental Delphi process. Eye (Lond) 2024; 38:1349-1354. [PMID: 38155328 PMCID: PMC11076634 DOI: 10.1038/s41433-023-02902-4] [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: 02/07/2023] [Revised: 12/05/2023] [Accepted: 12/12/2023] [Indexed: 12/30/2023] Open
Abstract
BACKGROUND Climate change is arguably the greatest threat to global health of the 21st century. Although cataract surgery is a major contributor to global greenhouse gas emissions, recent literature review identified a paucity of evidence-based strategies for improving the environmental impact of cataract services. Our study aimed to assess the effectiveness of a departmental Delphi process for improving cataract services' environmental sustainability. METHODS All members of ophthalmology theatre teams in a UK teaching hospital were invited to participate in a three-stage Delphi process. Team members were surveyed for suggestions for reducing the department's environmental impact. Suggested interventions were refined during a plenary face-to-face discussion and ranked. The highest ranked interventions were combined into a mutually agreed action plan. Data on the economic and environmental cost of cataract services was collected prior to and six months after the Delphi process using the Eyefficiency mobile application. RESULTS Twenty-three interventions were suggested by a range of staff cadres. Interventions were ranked by 24 team members. The 2nd, 4th, 5th, 8th and 11th ranked interventions were combined into an "Eco-packs" project in collaboration with suppliers (Bausch + Lomb), saving 675 kg of waste and 350 kg of CO2 equivalent annually. CONCLUSIONS The Delphi process is an effective method for provoking departmental engagement with the sustainability agenda that we would encourage all ophthalmology departments to consider utilising. The baseline per case CO2 equivalent measured in our department was reproducible and could serve as a maximum benchmark to be improved upon.
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Affiliation(s)
- Jonathan Malcolm
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK.
| | - Amy Dodd
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - Mohammad Shaikh
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | | | - John C Buchan
- Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
- International Centre for Eye Health, London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
- Royal College of Ophthalmologists' National Ophthalmology Database, 18 Stephenson Way, London, NW1 2HD, UK
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Asamoto S, Sawada H, Muto J, Arai T, Kawamata T. Green Hospital as a new Standard in Japan: How far can Neurosurgery go in Japan? World Neurosurg 2024; 187:150-155. [PMID: 38649025 DOI: 10.1016/j.wneu.2024.04.086] [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: 03/31/2024] [Revised: 04/14/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Climate change is a significant challenge that the medical community must address. Hospitals are large facilities with high water and energy consumption, as well as high levels of waste generation, which makes it important to pursue green hospital initiatives. Neurosurgery requires substantial energy for surgeries and tests. METHODS Based on the keywords "Climate change," "green hospital," "neurosurgery," "energy consumption," "environmental impact" listed in this paper, we extracted representative manuscripts, and the practices employed in the authors' hospital were assessed. RESULTS The "Guidelines for Environmental Consideration in Hospitals" and "Guidelines for the Sustainability of Hospital Environments" have been developed; however, they are not implemented in most hospitals in Japan. Inhalational anesthetics were found to contribute significantly to greenhouse gas emissions. Educating patients and staff and employing the "8 Rs" (rethink, refuse, reduce, reuse, recycle, research, renovation, and revolution) showed promise in achieving green hospital standards. CONCLUSIONS The advent of 'green hospitals' in Japan is imminent. The active participation of neurosurgeons can play a crucial role in diminishing the environmental footprint of health care while simultaneously enhancing medical standards. Given the pressing challenges posed by climate change, there is a critical need for an overhaul of medical practices. It is imperative for neurosurgeons to pioneer the adoption of new, sustainable medical methodologies.
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Affiliation(s)
- Shunji Asamoto
- Department of Neurosurgery, Makita General Hospital, Tokyo, Japan; Sustainability Director, Green Sports Alliance, Tokyo, Japan; Executive Director, Green Sports Alliance, Tokyo, Japan.
| | - Haruki Sawada
- Executive Director, Green Sports Alliance, Tokyo, Japan
| | - Jun Muto
- Department of Neurosurgery, Fujita Health University Hospital, Toyoake City, Japan
| | - Takashi Arai
- Department of Neurosurgery, Tokyo Women's Medical University Hospital, Tokyo, Japan
| | - Takakazu Kawamata
- Department of Neurosurgery, Tokyo Women's Medical University Hospital, Tokyo, Japan
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Birtel J, Hammer M, Feltgen N, Pauleikhoff L, Ong AY, Geerling G, Spitzer MS, Charbel Issa P. Intravitreal Injections: Improving Sustainability by Reducing Clinical Waste. Klin Monbl Augenheilkd 2024. [PMID: 38574679 DOI: 10.1055/a-2184-9492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
BACKGROUND Intravitreal injections are one of the most commonly performed ophthalmic procedures. It is estimated that over 1 million intravitreal injections are performed in Germany annually. The aim of this study was to quantify the waste and carbon footprint associated with single-use injection sets, and to establish a waste reduction strategy. MATERIAL AND METHODS The clinical waste and associated carbon footprint from standard disposable injection sets used by tertiary referral centres in Germany (n = 6) and the United Kingdom (n = 2) were assessed. The safety of performing intravitreal injections with a minimalistic material-sparing approach was evaluated. RESULTS The average weight of an injection set (and hence the waste generated from each injection) was 165 g. On average, each injection set comprised 145 g (88%) of plastic, 2.1 g (1.3%) of metal, 4.3 g (2.6%) of paper, and 12.9 g (7.8%) of gauze/swabs. The production of such injection sets was extrapolated to a CO2 equivalent of 752.6 tonnes (t), and the incineration of the resulting waste to a CO2 equivalent of 301.7 t. For 1 million injections, this equates to 145.2 t of plastic, 2.1 t of metal, 4.3 t of paper, and 12.9 t of gauze/swabs. A material-sparing approach can reduce injection set-associated waste by 99% without necessarily compromising patient safety. CONCLUSION A resource-saving approach to intravitreal injections can minimise the generation of clinical waste and its associated carbon footprint, thereby supporting sustainability.
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Affiliation(s)
- Johannes Birtel
- Oxford Eye Hospital, Oxford University, Oxford, United Kingdom
- Nuffield Laboratory of Ophthalmology, University of Oxford Nuffield Department of Clinical Neurosciences, Oxford, United Kingdom
- Klinik für Augenheilkunde, Universitätsklinikums Hamburg-Eppendorf, Hamburg, Deutschland
- Klinik für Augenheilkunde, Universitätsklinikum Bonn, Deutschland
| | | | | | - Laurenz Pauleikhoff
- Klinik für Augenheilkunde, Universitätsklinikums Hamburg-Eppendorf, Hamburg, Deutschland
| | - Ariel Yuhan Ong
- Oxford Eye Hospital, Oxford University, Oxford, United Kingdom
| | - Gerd Geerling
- Klinik für Augenheilkunde, Universitätsklinikum Düsseldorf, Deutschland
| | - Martin S Spitzer
- Klinik für Augenheilkunde, Universitätsklinikums Hamburg-Eppendorf, Hamburg, Deutschland
| | - Peter Charbel Issa
- Oxford Eye Hospital, Oxford University, Oxford, United Kingdom
- Nuffield Laboratory of Ophthalmology, University of Oxford Nuffield Department of Clinical Neurosciences, Oxford, United Kingdom
- Universitäts-Augenklinik, Klinikum rechts der Isar, Technische Universität München (TUM), München, Deutschland
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Latham SG, Williams RL, Grover LM, Rauz S. Achieving net-zero in the dry eye disease care pathway. Eye (Lond) 2024; 38:829-840. [PMID: 37957294 DOI: 10.1038/s41433-023-02814-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 09/27/2023] [Accepted: 10/25/2023] [Indexed: 11/15/2023] Open
Abstract
Climate change is a threat to human health and wellbeing across the world. In recent years, there has been a surge in awareness of this crisis, leading to many countries and organisations setting "net-zero" targets. This entails minimising carbon emissions and neutralising remaining emissions by removing carbon from the atmosphere. At the 2022 United Nations Climate Change Conference (COP27), commitments to transition away from fossil fuels and augment climate targets were underwhelming. It is therefore imperative for public and private sector organisations to demonstrate successful implementation of net-zero and set a precedent for the global political consensus. As a top 10 world employer, the United Kingdom National Health Service (NHS) has pledged to reach net-zero by 2045. The NHS has already taken positive steps forward, but its scale and complexity as a health system means stakeholders in each of its services must highlight the specifications for further progress. Dry eye disease is a chronic illness with an estimated global prevalence of 29.5% and an environmentally damaging care pathway. Moreover, environmental damage is a known aggravator of dry eye disease. Worldwide management of this illness generates copious amounts of non-recyclable waste, utilises inefficient supply chains and involves recurrent follow-up appointments and prescriptions. By mapping the dry eye disease care pathway to environmental impact, in this review we will highlight seven key areas in which reduced emissions and pollution could be targeted. Examining these approaches for improved environmental sustainability is critical in driving the transformation needed to preserve our health and wellbeing.
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Affiliation(s)
- Samuel G Latham
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Richard L Williams
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, UK
- Healthcare Technologies Institute, University of Birmingham, Birmingham, UK
| | - Liam M Grover
- School of Chemical Engineering, College of Engineering and Physical Sciences, University of Birmingham, Birmingham, UK
- Healthcare Technologies Institute, University of Birmingham, Birmingham, UK
| | - Saaeha Rauz
- Academic Unit of Ophthalmology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
- Birmingham and Midland Eye Centre, Sandwell and West Birmingham NHS Trust, Birmingham, UK.
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de'Angelis N, Conso C, Bianchi G, Rodríguez AGB, Marchegiani F, Carra MC, Lafont C, Canouï-Poitrine F, Slim K, Pessaux P. Systematic review of carbon footprint of surgical procedures. J Visc Surg 2024; 161:7-14. [PMID: 38087700 DOI: 10.1016/j.jviscsurg.2023.03.002] [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] [Indexed: 05/01/2024]
Abstract
The ecological sustainability of the operating room (OR) is a matter of recent interest. The present systematic review aimed to review the current literature assessing the carbon footprint of surgical procedures in different surgical fields. Following to the PRISMA statement checklist, three databases (MEDLINE, EMBASE, Cochrane Library) were searched by independent reviewers, who screened records on title and abstract first, and then on the full text. Risk of bias was evaluated using the MINORS system. Over the 878 articles initially identified, 36 original studies were included. They considered ophthalmologic surgical procedures (30.5%), general/digestive surgery (19.4%), gynecologic procedures (13.9%), orthopedic procedures (8.3%), neurosurgery (5.5%), otolaryngology/head and neck surgery (5.5%), plastic/dermatological surgery (5.5%), and cardiac surgery (2.8%). Despite a great methodological heterogeneity, data showed that a single surgical procedure emits 4-814 kgCO2e, with anesthetic gases and energy consumption representing the largest sources of greenhouse gas emission. Minimally invasive surgical techniques may require more resources than conventional open surgery, particularly for packaging and plastics, energy use, and waste production. Each OR has the potential to produce from 0.2 to 4kg of waste per case with substantial differences depending on the type of intervention, hospital setting, and geographic area. Overall, the selected studies were found to be of moderate quality. Based on a qualitative synthesis of the available literature, the OR can be targeted by programs and protocols implemented to reduce the carbon footprint and improve the waste stream of the OR.
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Affiliation(s)
- Nicola de'Angelis
- DIGEST department, unit of colorectal and digestive surgery, faculty of medicine, Beaujon university hospital, university of Paris Cité, AP-HP, Paris, France
| | - Christel Conso
- Service de chirurgie orthopedique, Institut Mutualiste Montsouris, 42, boulevard Jourdan, 75014 Paris, France
| | - Giorgio Bianchi
- DIGEST department, unit of colorectal and digestive surgery, faculty of medicine, Beaujon university hospital, university of Paris Cité, AP-HP, Paris, France
| | - Ana Gabriela Barría Rodríguez
- DIGEST department, unit of colorectal and digestive surgery, faculty of medicine, Beaujon university hospital, university of Paris Cité, AP-HP, Paris, France
| | - Francesco Marchegiani
- DIGEST department, unit of colorectal and digestive surgery, faculty of medicine, Beaujon university hospital, university of Paris Cité, AP-HP, Paris, France
| | - Maria Clotilde Carra
- Service of odontology, department of periodontology, Rothschild hospital, U.F.R. of odontology-Garancière, université de Paris, AP-HP, 75006 Paris, France
| | - Charlotte Lafont
- Service de santé publique, hôpital Henri-Mondor, 94010 Créteil cedex, France; IMRB, Inserm U955, équipe Clinical Epidemiology And Ageing (CEpiA), université Paris Est Créteil (UPEC), France
| | - Florence Canouï-Poitrine
- Service de santé publique, hôpital Henri-Mondor, 94010 Créteil cedex, France; IMRB, Inserm U955, équipe Clinical Epidemiology And Ageing (CEpiA), université Paris Est Créteil (UPEC), France
| | - Karem Slim
- Department of digestive surgery, Francophone Group for Enhanced Recovery After Surgery (GRACE), university hospital, CHU Clermont-Ferrand, place Lucie-Aubrac, 63003 Clermont-Ferrand, France
| | - Patrick Pessaux
- Digestive surgery department, HPB unit, Nouvel Hôpital Civil, university of Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg, France.
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Kallay O, Sadad R, Zafzafi A, Motulsky E. Cataract surgery and environmental sustainability: a comparative analysis of single-use versus reusable cassettes in phacoemulsification. BMJ Open Ophthalmol 2024; 9:e001617. [PMID: 38531624 DOI: 10.1136/bmjophth-2023-001617] [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: 12/15/2023] [Accepted: 03/03/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVE To compare sustainability, financial implications and surgical efficiency of two phacoemulsification cassette systems for cataract surgery: a machine with single-use cassettes and another with daily, reusable ones. METHODS Observational study involving retrospective cataract surgery data collection at the Centre Médical de l'Alliance, Braine-l'Alleud, Belgium, a tertiary eye care centre. Information on cassette weight, quantities and transport volume was obtained from routine procedures and purchasing records. The costs for each machine were calculated by reviewing the invoices received from the accounting department. RESULTS We found significant differences across comparisons. The reusable cassette machine, when compared with the single-use machine, used 306.7 kg less plastic (75.3% reduction), required 2494 m3 less storage per 1000 surgeries (67.7% decrease) and cost €54.16 less per 10 procedures (16.9% reduction). The machine with daily reusable cassettes also exhibited a 7-minute priming time advantage for 10 procedures, reducing downtime between cases. CONCLUSIONS Our findings underscore the benefits of adopting reusable cassette systems: reduced plastic consumption, storage volume and priming time, as well as enhanced efficiency and cost-savings. Healthcare professionals and institutions are encouraged to embrace environmentally conscious initiatives. The use of reusable cassette systems for cataract surgeries offers a pathway to sustainable practices.
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Affiliation(s)
- Oscar Kallay
- Head of Department of Ophthalmology, Centre Médical de l'Alliance, Braine-l'Alleud, Belgium
| | - Rayane Sadad
- Department of Ophthalmology, Erasmus Hospital, Brussels, Belgium
| | - Ahmed Zafzafi
- Department of Ophthalmology, Centre Médical de l'Alliance, Braine-l'Alleud, Belgium
| | - Elie Motulsky
- Head of Departement of Ophthalmology, Erasmus Hospital, Brussels, Belgium
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Schehlein EM, Hovanesian J, Shukla AG, Talley Rostov A, Findl O, Chang DF. Reducing ophthalmic surgical waste through electronic instructions for use: a multisociety position paper. J Cataract Refract Surg 2024; 50:197-200. [PMID: 38141003 PMCID: PMC10878457 DOI: 10.1097/j.jcrs.0000000000001381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/03/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023]
Abstract
Every ophthalmic surgical supply, including intraocular lenses (IOLs), IOL cartridges, and ophthalmic viscosurgical device syringes, is packaged with instructions for use (IFU). These pamphlets are printed in multiple languages and, in the case of an IOL, significantly increase the size and weight of the packaging. To eliminate this significant and unnecessary source of waste, we recommend that manufacturers move to Quick Response codes that link to online electronic IFU (e-IFU) as a sensible alternative. In addition to reducing carbon emissions and manufacturing costs, e-IFU can be updated more easily and accessed by surgeons in the clinic, where IOL models and powers are selected. Varying and inconsistent IFU requirements between different countries are a barrier to wider adoption of e-IFU by the ophthalmic surgical industry. Regulatory agencies in every country should allow and encourage e-IFU. This position paper has been endorsed by the 3 major societies that sponsor EyeSustain, a consortium of global societies dedicated to advancing sustainability in ophthalmology.
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Affiliation(s)
- Emily M. Schehlein
- From the Brighton Vision Center, Brighton, Michigan (Schehlein); Harvard Eye Associates, Laguna Hills, California (Hovanesian); Columbia University Medical Center, New York, New York (Shukla); Himalayan Cataract Project (HCP) Cureblindness, Waterbury, Vermont (Rostov); Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria (Findl); Altos Eye Physicians, Los Altos, California (Chang)
| | - John Hovanesian
- From the Brighton Vision Center, Brighton, Michigan (Schehlein); Harvard Eye Associates, Laguna Hills, California (Hovanesian); Columbia University Medical Center, New York, New York (Shukla); Himalayan Cataract Project (HCP) Cureblindness, Waterbury, Vermont (Rostov); Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria (Findl); Altos Eye Physicians, Los Altos, California (Chang)
| | - Aakriti Garg Shukla
- From the Brighton Vision Center, Brighton, Michigan (Schehlein); Harvard Eye Associates, Laguna Hills, California (Hovanesian); Columbia University Medical Center, New York, New York (Shukla); Himalayan Cataract Project (HCP) Cureblindness, Waterbury, Vermont (Rostov); Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria (Findl); Altos Eye Physicians, Los Altos, California (Chang)
| | - Audrey Talley Rostov
- From the Brighton Vision Center, Brighton, Michigan (Schehlein); Harvard Eye Associates, Laguna Hills, California (Hovanesian); Columbia University Medical Center, New York, New York (Shukla); Himalayan Cataract Project (HCP) Cureblindness, Waterbury, Vermont (Rostov); Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria (Findl); Altos Eye Physicians, Los Altos, California (Chang)
| | - Oliver Findl
- From the Brighton Vision Center, Brighton, Michigan (Schehlein); Harvard Eye Associates, Laguna Hills, California (Hovanesian); Columbia University Medical Center, New York, New York (Shukla); Himalayan Cataract Project (HCP) Cureblindness, Waterbury, Vermont (Rostov); Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria (Findl); Altos Eye Physicians, Los Altos, California (Chang)
| | - David F. Chang
- From the Brighton Vision Center, Brighton, Michigan (Schehlein); Harvard Eye Associates, Laguna Hills, California (Hovanesian); Columbia University Medical Center, New York, New York (Shukla); Himalayan Cataract Project (HCP) Cureblindness, Waterbury, Vermont (Rostov); Vienna Institute for Research in Ocular Surgery (VIROS), Hanusch Hospital, Vienna, Austria (Findl); Altos Eye Physicians, Los Altos, California (Chang)
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Meiklejohn DA, Khan ZH, Nuñez KM, Imhof L, Osmani S, Benavidez AC, Tarefder R. Environmental Impact of Adult Tonsillectomy: Life Cycle Assessment and Cost Comparison of Techniques. Laryngoscope 2024; 134:622-628. [PMID: 37421241 DOI: 10.1002/lary.30866] [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: 05/04/2023] [Revised: 06/06/2023] [Accepted: 06/13/2023] [Indexed: 07/10/2023]
Abstract
OBJECTIVES To quantify and compare the cost and environmental impact of different techniques for adult tonsillectomy surgery, and to identify target areas for impact reduction. METHODS Fifteen consecutive adult tonsillectomy surgeries were prospectively randomized to one of three tonsillectomy techniques: cold, monopolar electrocautery, or low-temperature radiofrequency ablation (Coblation). Life cycle assessment was used to comprehensively evaluate the environmental impact of study surgeries. Outcomes assessed included multiple measures of environmental impact, including greenhouse gas (GHG) emissions, and cost. Environmental impact measures were analyzed to identify highest-yield areas for improvement, and outcomes were compared between surgical techniques using statistical analysis. RESULTS GHG emissions for cold, monopolar electrocautery, and Coblation techniques were 157.6, 184.5, and 204.7 kilograms of carbon dioxide equivalents (kgCO2 -eq) per surgery, respectively, with costs totaling $472.51, $619.10, and $715.53 per surgery, respectively. Regardless of surgery technique, anesthesia medications and disposable equipment contributed most to environmental harm. Cold technique demonstrated reduced environmental impact related to disposable surgical equipment in the categories of greenhouse gas emissions, acidification of soil and water, eutrophication of air, ozone depletion, release of carcinogenic, and non-carcinogenic toxic substances, and respiratory pollutant production (p < 0.05 for all comparisons with other techniques). CONCLUSION Within the boundaries of operating room processes, cold technique minimizes cost and environmental impact of adult tonsillectomy surgery, with statistical significance noted in the impact of disposable surgical equipment. Areas of highest potential for improvement identified include reducing use of disposable equipment and collaboration with the Anesthesiology care team to streamline medication use. LEVEL OF EVIDENCE 2, randomized trial Laryngoscope, 134:622-628, 2024.
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Affiliation(s)
- Duncan A Meiklejohn
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of New Mexico Hospital, Albuquerque, New Mexico, U.S.A
| | - Zafrul H Khan
- Department of Civil Engineering, University of New Mexico, Albuquerque, New Mexico, U.S.A
| | - Karyn M Nuñez
- Alaska Native Tribal Health Consortium, Providence Anchorage Anesthesia Medical Group, Anchorage, Alaska, U.S.A
| | - Lee Imhof
- Department of Planning and Construction, University of New Mexico Hospital, Albuquerque, New Mexico, U.S.A
| | - Sabah Osmani
- University of New Mexico School of Medicine, Albuquerque, New Mexico, U.S.A
| | - Amaris C Benavidez
- University of New Mexico School of Medicine, Albuquerque, New Mexico, U.S.A
| | - Rafiqul Tarefder
- Department of Civil Engineering, University of New Mexico, Albuquerque, New Mexico, U.S.A
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13
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Rougereau G, Chatelain L, Zadegan F, Conso C. Estimation of the carbon footprint of arthroscopic rotator cuff repairs in France. Orthop Traumatol Surg Res 2024; 110:103755. [PMID: 37949395 DOI: 10.1016/j.otsr.2023.103755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 06/20/2023] [Accepted: 06/30/2023] [Indexed: 11/12/2023]
Abstract
AIM The main objective of this study was to estimate the carbon impact of arthroscopic rotator cuff repairs in France. The secondary objective was to assess the effectiveness of the following measures in reducing the carbon footprint associated with this technique: outpatient treatment, arthroscopic water filtration, surgery under locoregional anesthesia. HYPOTHESIS The hypothesis was that the carbon footprint could be significantly improved with the implementation of these three procedures. METHODS A continuous series of 26 patients who underwent surgery for a rotator cuff tear involving only one tendon between November 2020 and April 2021 were included. The evaluation protocol consisted of three parts: 1/ use of volatile anesthetic agents; 2/ electrical consumption linked to the procedure; 3/ emissions related to patient and staff travel, delivery of implants and waste management. Another series of 26 patients operated between November 2018 and April 2019 who had none of these three factors were matched. RESULTS The carbon impact of arthroscopic repair of the rotator cuff was estimated at 334.61±18.82kgCO2eq. The implementation of the three methods for improvement made it possible to significantly reduce emissions by 40.9±1.71kgCO2eq (12.2%) (p<0.001). CONCLUSION Performing surgery under locoregional anesthesia, on an outpatient basis with water purification, reduces the carbon impact of arthroscopic rotator cuff repair by more than 12%. LEVEL OF EVIDENCE III, retrospective case control.
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Affiliation(s)
- Grégoire Rougereau
- Service de chirurgie orthopédique, Institut Mutualiste Montsouris, Paris, France; Service de chirurgie orthopédique et traumatologique, Hôpital Pitié-Salpêtrière, AP-HP, Paris, France.
| | - Léonard Chatelain
- Service de chirurgie orthopédique, Institut Mutualiste Montsouris, Paris, France
| | - Frédéric Zadegan
- Service de chirurgie orthopédique, Institut Mutualiste Montsouris, Paris, France
| | - Christel Conso
- Service de chirurgie orthopédique, Institut Mutualiste Montsouris, Paris, France
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Lam L, Bradbrook D, Gale J. Tracing the barriers to decarbonising ophthalmology: A review. Clin Exp Ophthalmol 2024; 52:78-90. [PMID: 38213078 DOI: 10.1111/ceo.14349] [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: 10/31/2023] [Revised: 12/02/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024]
Abstract
As climate change demands increasingly urgent mitigation of greenhouse gas emissions, the health sector needs to do its part to decarbonise. Ophthalmologists share concerns about climate change and seek opportunities to reduce their environmental impact. When measuring the footprint of ophthalmology, major contributions are from patient travel to clinics, and from the large amounts of single-use disposable materials that are consumed during surgeries and sterile procedures. Ophthalmic services in India have already demonstrated systems that consume far fewer of these products through efficient throughput of patients and the safe reuse of many items, while maintaining equivalent safety and quality outcomes. Choosing these low-cost low-emission options would seem obvious, but many ophthalmologists experience barriers that prevent them operating as Indian surgeons do. Understanding these barriers to change is a crucial step in the decarbonisation of ophthalmology and the health sector more broadly.
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Affiliation(s)
- Lydia Lam
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - Darren Bradbrook
- Surgery and Perioperative Medicine Division, Flinders Medical Centre, Bedford Park, South Australia, Australia
- Southern Adelaide Local Health Network (SALHN), Bedford Park, South Australia, Australia
| | - Jesse Gale
- Department of Surgery & Anaesthesia, University of Otago Wellington, Wellington, New Zealand
- Ophthalmology, Te Whatu Ora Health New Zealand Capital Coast & Hutt Valley, Wellington, New Zealand
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15
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Suvannachart P, Rujkorakarn P, Watha T, Srihatrai P. Evaluation of laser power stability of repeatedly used SubCyclo probe in micropulse transscleral cyclophotocoagulation for glaucoma: A step towards sustainable ophthalmic surgery. PLoS One 2023; 18:e0295517. [PMID: 38064479 PMCID: PMC10707564 DOI: 10.1371/journal.pone.0295517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 11/25/2023] [Indexed: 12/18/2023] Open
Abstract
PURPOSE To evaluate the laser power stability of the SubCyclo probe for micropulse transscleral cyclophotocoagulation after repeated use. MATERIALS AND METHODS This experimental study involved 6 new probes. Each probe was connected to the SubCyclo mode (2,000 mW power, 31.3% duty cycle, and 100 seconds duration) of the Vitra 810 laser delivery system (Quantel Medical, France). Laser power measurements were taken using a calibrated laser power meter (Nova, Ophir Optronics Solutions, Israel) every 10 seconds from 10 to 90 seconds during each of the 40 cycles. Intra-rater reliability was assessed using intraclass correlation (ICC). A linear mixed model for repeated measures and pairwise comparisons with Bonferroni adjustment were used for the analysis. RESULTS The mean (SD) power outputs of all probes for the first cycle and all cycles were 421.9 (19.7) mW and 436.7 (16.1) mW, respectively. During the first cycle, the mean (SD) laser power gradually decreased from 444.3 (13.4) mW at 10 seconds to 407.3 (17.0) mW at 90 seconds (Fig 3). For all cycles, the power was 446.0 (13.6) mW at 10 seconds and gradually declined to 426.8 (21.0) mW at 90 seconds. Pairwise comparisons revealed significant differences in mean laser power outputs after 16 cycles of repeated use compared to the first cycle. The ICC estimate (95% CI) for intra-rater reliability was 0.96 (0.89, 0.99). CONCLUSIONS The SubCyclo probe maintains stable laser power outputs throughout repeated use for up to 16 cycles, with a significant increase observed after 16 cycles.
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Affiliation(s)
- Pukkapol Suvannachart
- Department of Ophthalmology, Suddhavej Hospital, Faculty of Medicine, Mahasarakham University, Maha Sarakham, Thailand
| | - Ploysai Rujkorakarn
- Department of Ophthalmology, Suddhavej Hospital, Faculty of Medicine, Mahasarakham University, Maha Sarakham, Thailand
| | - Thanita Watha
- Department of Ophthalmology, Suddhavej Hospital, Faculty of Medicine, Mahasarakham University, Maha Sarakham, Thailand
| | - Parinya Srihatrai
- Department of Ophthalmology, Suddhavej Hospital, Faculty of Medicine, Mahasarakham University, Maha Sarakham, Thailand
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16
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Fogarty AE, Wilson A, Godambe M, Shinde N, Gou C, Decker G, Steensma J. The carbon footprint of epidural steroid injections: A pilot study. PM R 2023. [PMID: 38037489 DOI: 10.1002/pmrj.13111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 10/22/2023] [Accepted: 11/11/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Epidural steroid injections are common procedures in physical medicine and rehabilitation practice. However, their environmental impact has not been characterized. OBJECTIVE The primary aim is to estimate and compare the carbon footprint of two standard injection kits used to perform epidural steroid injections at a single academic institution. Secondary objectives were (1) to create a step-by-step guide for estimating the carbon footprint of materials and (2) to survey physicians on practice patterns and identify areas for improvement. DESIGN Pilot study. SETTING Academic medical center. PARTICIPANTS N/A. INTERVENTIONS N/A. OUTCOME MEASURES Carbon emissions measured in CO2 equivalents (CO2 eq). METHODS Using guidance from the Greenhouse Gas Protocol, the carbon footprint of the two kits was estimated by taking the sum of carbon emissions resulting from the production of the kit materials and the carbon emissions resulting from the waste disposal of the kit materials. RESULTS The carbon footprint of the transforaminal epidural steroid injection (TFESI) kit was estimated at 1.328 kg CO2 eq. The carbon footprint of the interlaminar epidural steroid injection (ILESI) kit was estimated at 2.534 kg CO2 eq. For both kits, the carbon emissions resulting from the production of the kits were greater than the emissions resulting from disposal. The survey of interventionalists performing TFESI revealed all respondents required materials in addition to those provided in the standard epidural kit. Despite this, kit materials were typically wasted in 62% of respondents. CONCLUSION Creating a methodology for quantifying carbon emissions is the first step to reducing carbon emissions. Once emissions are measured, the health care industry can determine the most effective strategies for reducing its impact. Our analysis has shown that it is feasible to perform emissions calculations and delineates a clear method with publicly available resources. Solutions to reduce epidural injection carbon footprint waste may include improved kit customization.
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Affiliation(s)
- Alexandra E Fogarty
- Department of Orthopaedic Surgery, Division of Physical Medicine & Rehabilitation, Washington University School of Medicine, Campus Box 8233, Saint Louis, Missouri, USA
| | - Annalee Wilson
- Brown School, Washington University in St. Louis, One Booking Drive, Campus Box 1196, St. Louis, Missouri, USA
| | - Maya Godambe
- Brown School, Washington University in St. Louis, One Booking Drive, Campus Box 1196, St. Louis, Missouri, USA
| | - Nidhi Shinde
- Brown School, Washington University in St. Louis, One Booking Drive, Campus Box 1196, St. Louis, Missouri, USA
| | - Christine Gou
- Department of Orthopaedic Surgery, Division of Physical Medicine & Rehabilitation, Washington University School of Medicine, Campus Box 8233, Saint Louis, Missouri, USA
| | - Gregory Decker
- Department of Orthopaedic Surgery, Division of Physical Medicine & Rehabilitation, Washington University School of Medicine, Campus Box 8233, Saint Louis, Missouri, USA
| | - Joe Steensma
- Brown School, Washington University in St. Louis, One Booking Drive, Campus Box 1196, St. Louis, Missouri, USA
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17
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McCance E, Taylor HR, Acharya NR, Thiel CL, Resnikoff S, Bourne R. National Eye Institute's (NEI) coordination efforts and current opportunities for sustainability, adaptation, and climate resilience in global eye health - ARVO 2023 session commentary. Eye (Lond) 2023:10.1038/s41433-023-02854-9. [PMID: 38036610 DOI: 10.1038/s41433-023-02854-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 12/02/2023] Open
Affiliation(s)
- Eleanor McCance
- Department of Ophthalmology, Royal Glamorgan Hospital, Llantrisant, UK.
| | - Hugh R Taylor
- Melbourne School of Population and Global Health, Melbourne, VIC, Australia
| | - Nisha R Acharya
- Departments of Ophthalmology and Epidemiology, University of California, San Francisco, USA
| | - Cassandra L Thiel
- Department of Population Health & Ophthalmology, New York University, New York, NY, USA
| | - Serge Resnikoff
- School of Optometry and Vision Sciences, University of New South Wales, Sydney, NSW, Australia
| | - Rupert Bourne
- Cambridge Eye Research Centre, Addenbrookes Hospital, Cambridge, UK
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18
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Tsagkaris C, Saeed H, Laubscher L, Eleftheriades A, Stavros S, Drakaki E, Potiris A, Panagiotopoulos D, Sioutis D, Panagopoulos P, Zil-E-Ali A. Eco-Friendly and COVID-19 Friendly? Decreasing the Carbon Footprint of the Operating Room in the COVID-19 Era. Diseases 2023; 11:157. [PMID: 37987268 PMCID: PMC10660860 DOI: 10.3390/diseases11040157] [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: 10/12/2023] [Revised: 10/27/2023] [Accepted: 10/30/2023] [Indexed: 11/22/2023] Open
Abstract
Surgery is one of the most energy-intensive branches of healthcare. Although the COVID-19 pandemic has reduced surgical volumes, infection control protocols have increased the ecological footprint of surgery owing to the extensive use of personal protective equipment, sanitation, testing and isolation resources. The burden of environmental diseases requiring surgical care, the international commitment towards environmental sustainability and the global efforts to return to the pre-pandemic surgical workflow call for action towards climate-friendly surgery. The authors have searched the peer-reviewed and gray literature for clinical studies, reports and guidelines related to the ecological footprint of surgical care and the available solutions and frameworks to reduce it. Numerous studies concede that surgery is associated with a high rate of energy utilization and waste generation that is comparable to major non-medical sources of pollution. Recommendations and research questions outlining environmentally sustainable models of surgical practices span from sanitation and air quality improvement systems to the allocation of non-recyclable consumables and energy-efficient surgical planning. The latter are particularly relevant to infection control protocols for COVID-19. Paving the way towards climate-friendly surgery is a worthy endeavor with a major potential to improve surgical practice and outcomes in the long term.
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Affiliation(s)
- Christos Tsagkaris
- Public Health and Policy Working Group, Stg European Student Think Tank, Postjeskade 29, 1058 DE Amsterdam, The Netherlands
| | - Hamayle Saeed
- Fatima Memorial Hospital College of Medicine & Dentistry, Lahore 54000, Pakistan
| | - Lily Laubscher
- Department of Health Sciences, Swiss Federal Institute of Technology Zurich, 8092 Zurich, Switzerland
| | - Anna Eleftheriades
- Faculty of Medicine, National and Kapodistrian University of Athens, 115 27 Athens, Greece
| | - Sofoklis Stavros
- 3rd Department of Ob/Gyn, Attikon University Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece
| | - Eirini Drakaki
- 3rd Department of Ob/Gyn, Attikon University Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece
| | - Anastasios Potiris
- 3rd Department of Ob/Gyn, Attikon University Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece
| | - Dimitrios Panagiotopoulos
- 3rd Department of Ob/Gyn, Attikon University Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece
| | - Dimos Sioutis
- 3rd Department of Ob/Gyn, Attikon University Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece
| | - Periklis Panagopoulos
- 3rd Department of Ob/Gyn, Attikon University Hospital, National and Kapodistrian University of Athens, 124 62 Athens, Greece
| | - Ahsan Zil-E-Ali
- Department of Heart and Vascular Institute, The Pennsylvania State University College of Medicine, Hershey, PA 17033, USA
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Bhopal A, Sharma S, Norheim OF. Balancing the health benefits and climate mortality costs of haemodialysis. Future Healthc J 2023; 10:308-312. [PMID: 38162214 PMCID: PMC10753215 DOI: 10.7861/fhj.2022-0127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Extensive work is underway to quantify the carbon footprint of specific healthcare interventions and identify ways to minimise healthcare-related emissions; however, it remains unclear how to balance the relative benefits from delivering healthcare with the harm from the associated carbon footprint. To estimate emissions-related harms, we used the Mortality Cost of Carbon, a recently developed metric from environmental economics, which presents the impacts of carbon emissions in the form of excess deaths. We convert deaths into years of life lost and compare this with the healthy life years gained, under two temperature scenarios: 'Dynamic Integrated Climate Economy Model with an Endogenous Mortality Response' (DICE-EMR) (2.4°C) and 'DICE-Baseline' (4.1°C). As a case study, we use haemodialysis, a life-prolonging intervention with a large carbon footprint. We estimate that 19-53 and 10-25 healthy life years are gained from haemodialysis per year of life lost from the associated emissions in the DICE-EMR and DICE-Baseline scenarios, respectively, depending on the country and treatment regimen. This brings the distribution of harms, benefits and tradeoffs inherent to the decarbonisation of healthcare into sharper focus. More fully accounting for the harm imposed by carbon emissions could result in better value investments to lower the carbon footprint of interventions and support the implementation of the net-zero healthcare agenda.
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Affiliation(s)
- Anand Bhopal
- Bergen Centre for Ethics and Priority Setting in Health (BCEPS), University of Bergen, Bergen, Norway
| | - Siddhanth Sharma
- Bergen Centre for Ethics and Priority Setting in Health (BCEPS), University of Bergen, Bergen, Norway
| | - Ole F Norheim
- Bergen Centre for Ethics and Priority Setting in Health (BCEPS), University of Bergen, Bergen, Norway, and adjunct professor of global health and population, Harvard University, Boston, MA, USA
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Anudjo MNK, Vitale C, Elshami W, Hancock A, Adeleke S, Franklin JM, Akudjedu TN. Considerations for environmental sustainability in clinical radiology and radiotherapy practice: A systematic literature review and recommendations for a greener practice. Radiography (Lond) 2023; 29:1077-1092. [PMID: 37757675 DOI: 10.1016/j.radi.2023.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/01/2023] [Accepted: 09/11/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Environmental sustainability (ES) in healthcare is an important current challenge in the wider context of reducing the environmental impacts of human activity. Identifying key routes to making clinical radiology and radiotherapy (CRR) practice more environmentally sustainable will provide a framework for delivering greener clinical services. This study sought to explore and integrate current evidence regarding ES in CRR departments, to provide a comprehensive guide for greener practice, education, and research. METHODS A systematic literature search and review of studies of diverse evidence including qualitative, quantitative, and mixed methods approach was completed across six databases. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines and the Quality Assessment Tool for Studies with Diverse Designs (QATSDD) was used to assess the included studies. A result-based convergent data synthesis approach was employed to integrate the study findings. RESULTS A total of 162 articles were identified. After applying a predefined exclusion criterion, fourteen articles were eligible. Three themes emerged as potentially important areas of CRR practice that contribute to environmental footprint: energy consumption and data storage practices; usage of clinical consumables and waste management practices; and CRR activities related to staff and patient travel. CONCLUSIONS Key components of CRR practice that influence environmental impact were identified, which could serve as a framework for exploring greener practice interventions. Widening the scope of research, education and awareness is imperative to providing a holistic appreciation of the environmental burden of healthcare. IMPLICATIONS FOR PRACTICE Encouraging eco-friendly travelling options, leveraging artificial Intelligence (AI) and CRR specific policies to optimise utilisation of resources such as energy and radiopharmaceuticals are recommended for a greener practice.
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Affiliation(s)
- M N K Anudjo
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, UK
| | - C Vitale
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, UK; IRCCS San Raffaele Hospital, Milan, Italy
| | - W Elshami
- Department of Medical Diagnostic Imaging, College of Health Sciences, University of Sharjah, United Arab Emirates
| | - A Hancock
- Department of Medical Imaging, University of Exeter, Exeter, UK
| | - S Adeleke
- School of Cancer & Pharmaceutical Sciences, King's College London, Queen Square, London WC1N 3BG, UK; High Dimensional Neurology, Department of Brain Repair and Rehabilitation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - J M Franklin
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, UK
| | - T N Akudjedu
- Institute of Medical Imaging & Visualisation, Department of Medical Science & Public Health, Faculty of Health & Social Sciences, Bournemouth University, UK.
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21
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Delaie C, Cerlier A, Argenson JN, Escudier JC, Khakha R, Flecher X, Jacquet C, Ollivier M. Ecological Burden of Modern Surgery: An Analysis of Total Knee Replacement's Life Cycle. Arthroplast Today 2023; 23:101187. [PMID: 37745969 PMCID: PMC10514426 DOI: 10.1016/j.artd.2023.101187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 07/06/2023] [Accepted: 07/08/2023] [Indexed: 09/26/2023] Open
Abstract
Background It is estimated that surgical procedures account for 20%-30% of the greenhouse gases emissions from health-care systems. Total knee replacements (TKR) are one of the most frequently performed procedures in orthopaedics. The aim of this study was to identify and quantify the environmental impacts generated by TKRs, the factors that generate the most emissions, and those that can be easily modified. Methods To calculate the life cycle carbon footprint of a posterior stabilized cemented TKR performed in a single orthopaedic surgery department, 17 TKRs performed between October 12 and 20, 2020 by 4 senior surgeons were analysed. The analysis of the life cycle included the manufacture of the implant, from raw materials to distribution; the journey made by patients and staff; and the surgery including all consumables required to facilitate the procedure. Results The overall life cycle carbon footprint of a single TKR was 190.5 kg of CO2. This consisted of 53.7 kg CO2 (28%) for the manufacture of the prosthesis, 50.9 kg CO2 (27%) for travel, 57.1 kg CO2 (30%) for surgery, and 28.8 kg CO2 (15%) for waste management. This is comparable to a New York-Detroit direct flight. Conclusions The production of a total knee prosthesis, throughout its life cycle, generates emissions with important consequences on the environment and therefore on our health. Although much data are currently missing to make precise estimates, and especially regarding benefits in terms of patient function and its impact on carbon emissions, these data serve as a starting point for other more detailed or comparative studies.
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Affiliation(s)
- Camille Delaie
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | - Alexandre Cerlier
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | - Jean-Noel Argenson
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | - Jean-Charles Escudier
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | - Raghbir Khakha
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | - Xavier Flecher
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | - Christophe Jacquet
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
| | - Matthieu Ollivier
- Aix-Marseille Université, CNRS, ISM UMR 7287, Marseille, France
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, Marseille, France
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McNamee C, Rakovac A, Cawley DT. Sustainable surgical practices: A comprehensive approach to reducing environmental impact. Surgeon 2023:S1479-666X(23)00093-8. [PMID: 37718181 DOI: 10.1016/j.surge.2023.08.007] [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: 06/22/2023] [Accepted: 08/28/2023] [Indexed: 09/19/2023]
Abstract
This paper presents a comprehensive overview of the environmental impact of surgical procedures and highlights potential strategies to reduce the associated greenhouse gas emissions. We discuss procurement, waste management, and energy consumption, providing examples of successful interventions in each area. We also emphasize the importance of adopting the Green Theatre Checklist as a useful tool for clinicians aiming to implement sustainable surgical practices.
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Affiliation(s)
- Conor McNamee
- University College Dublin, National University of Ireland, Belfield, Dublin 4, Ireland.
| | - Ana Rakovac
- Irish Doctors for the Environment, Ireland; Laboratory Medicine Department, Tallaght University Hospital, Dublin 24, Ireland
| | - Derek T Cawley
- Mater Private Hospital, Dublin 1, Ireland; Irish Doctors for the Environment, Ireland; Dept of Surgery, University of Galway, Ireland
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23
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Sijm-Eeken M, Jaspers M, Peute L. Identifying Environmental Impact Factors for Sustainable Healthcare: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6747. [PMID: 37754607 PMCID: PMC10531011 DOI: 10.3390/ijerph20186747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 09/04/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023]
Abstract
The healthcare industry has a substantial impact on the environment through its use of resources, waste generation and pollution. To manage and reduce its impact, it is essential to measure the pressures of healthcare activities on the environment. However, research on factors that can support these measurement activities is unbalanced and scattered. In order to address this issue, a scoping review was conducted with the aims of (i) identifying and organizing factors that have been used to measure environmental impact in healthcare practice and (ii) analyzing the overview of impact factors in order to identify research gaps. The review identified 46 eligible articles publishing 360 impact factors from original research in PubMed and EBSCO databases. These factors related to a variety of healthcare settings, including mental healthcare, renal service, primary healthcare, hospitals and national healthcare. Environmental impacts of healthcare were characterized by a variety of factors based on three key dimensions: the healthcare setting involved, the measurement component or scope, and the type of environmental pressure. The Healthcare Environmental Impact Factor (HEIF) scheme resulting from this study can be used as a tool for selecting measurable indicators to be applied in quality management and as a starting point for further research. Future studies could focus on standardizing impact factors to allow for cross-organization comparisons and on expanding the HEIF scheme by addressing gaps.
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Affiliation(s)
- Marieke Sijm-Eeken
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Center for Sustainable Healthcare, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Monique Jaspers
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Center for Human Factors Engineering of Health Information Technology, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Linda Peute
- Department of Medical Informatics, Amsterdam Public Health Research Institute, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
- Center for Human Factors Engineering of Health Information Technology, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
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24
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McClintic SM, Stashevsky AG. Assessing Strategies to Reduce the Carbon Footprint of the Annual Meeting of the American Academy of Ophthalmology. JAMA Ophthalmol 2023; 141:862-869. [PMID: 37561509 PMCID: PMC10416087 DOI: 10.1001/jamaophthalmol.2023.3516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/01/2023] [Indexed: 08/11/2023]
Abstract
Importance Greenhouse gas emissions associated with medical conferences have been associated with climate change, and the effects of climate change have been associated with an increased incidence of ophthalmic diseases. Identifying practical strategies associated with reducing these emissions may be warranted. Objective To assess greenhouse gas emissions associated with in-person and virtual meetings of the American Academy of Ophthalmology (AAO) and to conduct mitigation analyses to suggest strategies to reduce future emissions. Design, Setting, and Participants Quality improvement study in which attendee and conference data were used to estimate emissions from in-person (October 12 to October 15, 2019, San Francisco, California) and virtual (November 13 to November 15, 2020) AAO annual meetings for 35 104 attendees. The data were also used to perform mitigation analyses to assess whether meeting format alterations could be used to reduce future emissions. Data were analyzed from December 21, 2021, to April 18, 2022. Exposures Attendance at a selected meeting. Total attendance was 23 190 participants in 2019 and 11 914 participants in 2020. Main Outcomes and Measures Greenhouse gas emissions produced by the in-person meeting were estimated by calculating the equivalent metric tons of carbon dioxide (CO2) associated with attendee transportation, attendee accommodations, and the conference venue. Emissions produced by the virtual meeting were estimated by calculating the equivalent metric tons of CO2 associated with attendees' computer use, network data transfer, and video-conferencing server use. Mitigation analyses simulated the association of changing the meeting location and format with reductions in emissions. Results In this analysis, the 2019 in-person meeting produced 39 910 metric tons of CO2 (1.73 metric tons of CO2 per capita), and the 2020 virtual meeting produced 38.6 metric tons of CO2 (0.003 metric tons of CO2 per capita). Mitigation analyses showed that holding a single in-person meeting in Chicago, Illinois, rather than San Francisco, California, could be associated with transportation-related emissions reductions of 19% (emissions for the San Francisco meeting, 38 993 metric tons of CO2; for the Chicago meeting, 31 616 metric tons of CO2). Holding multiple in-person meetings in separate regions could be associated with transportation-related emissions reductions of as much as 38% (emissions for the San Francisco meeting, 38 993 metric tons of CO2; for multiple meeting scenario 2, 24 165 metric tons of CO2). Conclusions and Relevance This study found that the AAO's 2019 in-person meeting was associated with substantially higher greenhouse gas emissions compared with the 2020 virtual meeting, primarily due to transportation-related emissions. Increasing the proportion of virtual participants, holding the meeting in locations chosen to minimize transportation-related emissions, or offering multiple regional meeting locations may reduce the carbon footprint of future meetings.
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Lever M, Smetana N, Bechrakis NE, Foerster A. [Survey and reduction of waste production from eye surgery]. DIE OPHTHALMOLOGIE 2023; 120:932-939. [PMID: 37052707 DOI: 10.1007/s00347-023-01840-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/15/2023] [Accepted: 03/01/2023] [Indexed: 04/14/2023]
Abstract
BACKGROUND The health sector is facing new challenges due to the impact of climate change on health. At the same time, it significantly contributes to our society's climate footprint. Hospitals producing considerable amounts of waste are an important aspect of this burden. The aim of this work was to quantify the amount of waste produced by eye surgery and, as an optimization measure, to evaluate the effect of glass separation from residual waste. MATERIAL AND METHODS Over a 2-week period, the waste generated by eye operations in the surgical theater of our university hospital was measured. Another 2‑week long measurement was conducted after the initiation of glass separation from general waste. The data obtained allowed a comparison of the two periods, the type of waste (residual and recyclable) as well as the type of operation (intraocular, extraocular). Considering regional waste disposal costs, an economic comparison was also performed. RESULTS In the first measurement period (196 operations), a total of 549.6 kg of waste was generated, 87% (478.3 kg) of which was residual waste, corresponding to 14.3 tons of total waste annually. Intraocular procedures generated on average 80% more waste than extraocular procedures: 18.1 ± 3.9 kg and 11.4 ± 4.0 kg, respectively, per day and theater. Separation of glass from residual waste reduced its quantity by 7.2% in the second measurement period (197 procedures). As the disposal of glass is free of charge in the city of Essen, this resulted in a small economic advantage (extrapolated to 112 € per year). CONCLUSION The amount of waste generated by ophthalmic surgery is substantial, with a predominant proportion of non-recyclable residual waste. Intraocular operations are the cause of the majority of the waste produced. Simple measures, such as disposing of glass separately, are helpful and inexpensive to reduce the quantity of residual waste.
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Affiliation(s)
- Mael Lever
- Klinik für Augenheilkunde, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - Nicolai Smetana
- Klinik für Augenheilkunde, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Nikolaos E Bechrakis
- Klinik für Augenheilkunde, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - Andreas Foerster
- Klinik für Augenheilkunde, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
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26
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Taboun OS, Orr SMA, Pereira A, Choudhry N. Factors contributing to the carbon footprint of cataract surgery. J Cataract Refract Surg 2023; 49:759-763. [PMID: 37390323 DOI: 10.1097/j.jcrs.0000000000001204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/13/2023] [Indexed: 07/02/2023]
Abstract
The healthcare sector is a significant greenhouse gas emitter. Cataract surgery is a procedure that results in a large amount of carbon dioxide (CO2) emissions. We sought to review the literature for factors contributing to the carbon footprint of this procedure. The literature, although limited, varies greatly by region. The carbon footprint of cataract surgery ranged from approximately 6 kg CO2 equivalents in a center in India to 181.9 kg CO2 equivalents in a center in the United Kingdom. Factors contributing to the carbon footprint of cataract surgery included the procurement of materials, energy use, and the emissions associated with travel. Factors facilitating a lower carbon footprint include the reuse of surgical materials and more efficient autoclave settings. Potential areas for improvement to consider include the reduction in packaging material, the reuse of materials, and potentially reducing travel emissions by performing simultaneous bilateral cataract surgery.
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Affiliation(s)
- Omar Salem Taboun
- From the Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada (Taboun); Vitreous Retina Macula Specialists of Toronto, Toronto, Ontario, Canada (Orr, Choudhry); Octane Imaging Lab, Toronto, Ontario, Canada (Orr, Pereira, Choudhry); Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario Canada (Pereira, Choudhry)
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27
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Winklmair N, Kieselbach G, Bopp J, Amon M, Findl O. Potential environmental effect of reducing the variation of disposable materials used for cataract surgery. J Cataract Refract Surg 2023; 49:628-634. [PMID: 36806589 DOI: 10.1097/j.jcrs.0000000000001170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE To analyze the cataract package variability in 1 country, Austria. SETTING Austrian Departments of Ophthalmology. DESIGN Cross-sectional study. METHODS The cataract package components of 3 different Austrian hospitals were weighed and life cycle assessment on each product performed. This data was then extrapolated to the sales figures of the main Austrian cataract package suppliers to estimate the carbon footprint of all cataract packages used in Austria in 2021. RESULTS There were 55 different cataract package compositions in use with an average weight of 0.7 kg. These compositions differ significantly in weight and composition considering that the smallest package was 57% lighter than the largest package. The size of the surgical drapes also showed considerable variation, with a difference of up to 71%. This is substantial, considering that drapes and covers account for about 53% of the package weight. CONCLUSIONS There was a considerable variation in package composition and product size, which could provide opportunities to save carbon dioxide emissions in cataract surgery. If all Austrian eye departments were to reduce the material quantities and drape sizes to the lower third of the cataract packages used in the Austria in 2021, cataract package associated CO 2 emissions could be reduced by 34%.
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Affiliation(s)
- Nicolas Winklmair
- From the Vienna Institute for Research in Ocular Surgery (VIROS), A Karl Landsteiner Institute, Hanusch Hospital, Vienna, Austria (Winklmair, Findl); Department of Ophthalmology, Medical University Innsbruck, Innsbruck, Austria (Kieselbach); Sphera Solutions GmbH, Leinfelden-Echterdingen, Austria (Bopp); Academic Hospital St. John, Vienna, Austria (Amon); Sigmund Freud Private University, Vienna, Austria (Amon)
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Perry H, Reeves N, Ansell J, Cornish J, Torkington J, Morris DS, Brennan F, Horwood J. Innovations towards achieving environmentally sustainable operating theatres: A systematic review. Surgeon 2023; 21:141-151. [PMID: 35715311 DOI: 10.1016/j.surge.2022.04.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The NHS accounts for 5.4% of the UK's total carbon footprint, with the perioperative environment being the most resource hungry aspect of the hospital. The aim of this systematic review was to assimilate the published studies concerning the sustainability of the perioperative environment, focussing on the impact of implemented interventions. METHODS A systematic review was performed using Pubmed, OVID, Embase, Cochrane database of systematic reviews and Medline. Original manuscripts describing interventions aimed at improving operating theatre environmental sustainability were included. RESULTS 675 abstracts were screened with 34 manuscripts included. Studies were divided into broad themes; recycling and waste management, waste reduction, reuse, reprocessing or life cycle analysis, energy and resource reduction and anaesthetic gases. This review summarises the interventions identified and their resulting effects on theatre sustainability. DISCUSSION This systematic review has identified simple, yet highly effective interventions across a variety of themes that can lead to improved environmental sustainability of surgical operating theatres. Combining these interventions will likely result in a synergistic improvement to the environmental impact of surgery.
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Affiliation(s)
- Helen Perry
- University Hospital of Wales Healthcare NHS Trust: Cardiff and Vale University Health Board, UK; NHS Wales Health Education and Improvement Wales, UK.
| | - Nicola Reeves
- NHS Wales Health Education and Improvement Wales, UK; Aneurin Bevan Health Board, UK
| | - James Ansell
- University Hospital of Wales Healthcare NHS Trust: Cardiff and Vale University Health Board, UK
| | - Julie Cornish
- University Hospital of Wales Healthcare NHS Trust: Cardiff and Vale University Health Board, UK
| | - Jared Torkington
- University Hospital of Wales Healthcare NHS Trust: Cardiff and Vale University Health Board, UK
| | - Daniel S Morris
- University Hospital of Wales Healthcare NHS Trust: Cardiff and Vale University Health Board, UK
| | - Fiona Brennan
- University Hospital of Wales Healthcare NHS Trust: Cardiff and Vale University Health Board, UK
| | - James Horwood
- University Hospital of Wales Healthcare NHS Trust: Cardiff and Vale University Health Board, UK
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29
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Redvers N, Wright K, Hartmann-Boyce J, Tonkin-Crine S. Physicians' views of patient-planetary health co-benefit prescribing: a mixed methods systematic review. Lancet Planet Health 2023; 7:e407-e417. [PMID: 37164517 DOI: 10.1016/s2542-5196(23)00050-5] [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] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 05/12/2023]
Abstract
Health professionals are increasingly called to become partners in planetary health. Using patient-planetary health (P-PH) co-benefit prescribing framing, we did a mixed methods systematic review to identify barriers and facilitators to adopting P-PH co-benefit prescribing by physicians and mapped these onto the Capability, Opportunity, Motivation, and Behaviour (COM-B) model and Theoretical Domains Framework (TDF). We searched electronic databases from inception until October, 2022, and did a content analysis of the included articles (n=12). Relevant categories were matched to items in the COM-B model and TDF. Nine barriers and eight facilitators were identified. Barriers included an absence of, or little, knowledge of how to change practice and time to implement change; facilitators included having policy statements and guidelines from respected associations. More diverse study designs that include health professionals, patients, and health-care system stakeholders are needed to ensure a more holistic understanding of the individual, system, and policy levers involved in implementing clinical work informed by planetary health.
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Affiliation(s)
- Nicole Redvers
- Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Department for Continuing Education, University of Oxford, Oxford, UK; Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - Kyla Wright
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, Canada
| | - Jamie Hartmann-Boyce
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Sarah Tonkin-Crine
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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McNamee C, Rakovac A, Cawley DT. The Environmental Impact of Spine Surgery and the Path to Sustainability. Spine (Phila Pa 1976) 2023; 48:545-551. [PMID: 36580585 DOI: 10.1097/brs.0000000000004550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 11/18/2022] [Indexed: 12/31/2022]
Abstract
STUDY DESIGN Narrative literature review. OBJECTIVE The aim of this study was to review published literature discussing sustainable health care and to identify aspects that pertain to spine surgery. SUMMARY OF BACKGROUND DATA In recent years, research has investigated the contribution of surgical specialties to climate change. To our knowledge, no article has yet been published discussing the impact specific to spinal procedures and possible mitigation strategies. METHODS A literature search was performed for the present study on relevant terms across four electronic databases. References of included studies were also investigated. RESULTS Spine surgery has a growing environmental impact. Investigations of analogous specialties find that procurement is the single largest source of emissions. Carbon-conscious procurement strategies will be needed to mitigate this fully, but clinicians can best reduce their impact by adopting a minimalist approach when using surgical items. Reduced wastage of disposable goods and increased recycling are beneficial. Technology can aid remote access to clinicians, and also enable patient education. CONCLUSIONS Spine-surgery-specific research is warranted to evaluate its carbon footprint. A broad range of measures is recommended from preventative medicine to preoperative, intraoperative, and postoperative spine care. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Conor McNamee
- University College Dublin, National University of Ireland, Belfield, Dublin, Ireland
| | - Ana Rakovac
- Irish Doctors for the Environment
- Laboratory Medicine Department, Tallaght University Hospital, Dublin, Ireland
| | - Derek T Cawley
- Mater Private Hospital, Dublin, Ireland
- Irish Doctors for the Environment
- Department of Surgery, University of Galway, Galway, Ireland
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31
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Sherry B, Lee S, Ramos Cadena MDLA, Laynor G, Patel SR, Simon MD, Romanowski EG, Hochman SE, Schuman JS, Prescott C, Thiel CL. How Ophthalmologists Can Decarbonize Eye Care: A Review of Existing Sustainability Strategies and Steps Ophthalmologists Can Take. Ophthalmology 2023:S0161-6420(23)00137-9. [PMID: 36889466 DOI: 10.1016/j.ophtha.2023.02.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/13/2023] [Accepted: 02/27/2023] [Indexed: 03/08/2023] Open
Abstract
TOPIC Understanding approaches to sustainability in cataract surgery and their risks and benefits CLINICAL RELEVANCE: In the United States, healthcare is responsible for approximately 8.5% of greenhouse gas (GHG), and cataract surgery is one of the most commonly performed surgical procedures. Ophthalmologists can contribute to reducing GHG emissions, which lead to a steadily increasing list of health concerns ranging from trauma to food instability. METHODS We conducted a literature review to identify the benefits and risks of sustainability interventions. We then organized these interventions into a decision tree for use by individual surgeons. RESULTS Identified sustainability interventions fall into the domains of advocacy and education, pharmaceuticals, process, and supplies and waste. Existing literature shows certain interventions may be safe, cost-effective, and environmentally friendly. These include dispensing medications home to patients after surgery, multi-dosing appropriate medications, training staff to properly sort medical waste, reducing the number of supplies used during surgery, and implementing immediate sequential bilateral cataract surgery where clinically appropriate. The literature was lacking on the benefits or risks for some interventions, such as switching specific single use supplies to reusables or implementing a hub-and-spoke style theatre setup. Many of the advocacy and education interventions have inadequate literature specific to ophthalmology but are likely to have minimal risks. CONCLUSIONS Ophthalmologists can engage in a variety of safe and effective approaches to reduce or eliminate dangerous GHG emissions associated with cataract surgery.
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Affiliation(s)
| | - Samuel Lee
- NYU Langone Health, NYU Langone Hospitals
| | | | | | | | | | - Eric G Romanowski
- Research Director of The Charles T. Campbell Ophthalmic Microbiology Laboratory; Research Instructor of Ophthalmology, Department of Ophthalmology University of Pittsburgh School of Medicine Pittsburgh, PA
| | - Sarah E Hochman
- Assistant Professor, Department of Medicine, Division of Infectious Diseases and Immunology, NYU Grossman School of Medicine
| | | | - Christina Prescott
- Residency Program Director; Vice Chair for Education; Director of the Cornea Service; Department of Ophthalmology, NYU Langone Health, New York University, New York, New York, 10017, USA
| | - Cassandra L Thiel
- Assistant Professor Department of Population Health, NYU Grossman School of Medicine.
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32
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Hong Z, Chong EW, Chan HHL. One step forward to sustainability: The carbon footprint of cataract surgery in Australia. Clin Exp Ophthalmol 2023; 51:180-182. [PMID: 36478628 DOI: 10.1111/ceo.14193] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 11/13/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Zixin Hong
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Elaine W Chong
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Centre for Eye Research Australia, Melbourne, Victoria, Australia
| | - Helen H L Chan
- Department of Ophthalmology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia.,Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia
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33
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Ditac G, Cottinet PJ, Quyen Le M, Grinberg D, Duchateau J, Gardey K, Dulac A, Delinière A, Haddad C, Boussuge-Roze J, Sacher F, Jaïs P, Chevalier P, Bessière F. Carbon footprint of atrial fibrillation catheter ablation. Europace 2023; 25:331-340. [PMID: 36107465 PMCID: PMC10103577 DOI: 10.1093/europace/euac160] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/08/2022] [Indexed: 11/13/2022] Open
Abstract
AIMS Climate change represents the biggest global health threat of the 21st century. Health care system is itself a large contributor to greenhouse gas (GHG) emissions. In cardiology, atrial fibrillation (AF) catheter ablation is an increasing activity using numerous non-reusable materials that could contribute to GHG emission. Determining a detailed carbon footprint analysis of an AF catheter ablation procedure allows the identification of the main polluting sources that give opportunities for reduction of environmental impact. To assess the carbon footprint of AF catheter ablation procedure. To determine priority actions to decrease pollution. METHODS AND RESULTS An eco-audit method used to predict the GHG emission of an AF catheter ablation procedure was investigated. Two workstations were considered including surgery and anaesthesia. In the operating room, every waste produced by single-use medical devices, pharmaceutical drugs, and energy consumption during intervention were evaluated. All analyses were limited to the operating room. Thirty procedures were analysed over a period of 8 weeks: 18 pulmonary veins isolation RF ablations, 7 complex RF procedures including PVI, roof and mitral isthmus lines, ethanol infusion of the Marshall vein and cavo tricuspid isthmus line, and 5 pulmonary vein isolation with cryoballoon. The mean emission during AF catheter ablation procedures was 76.9 kg of carbon dioxide equivalent (CO2-e). The operating field accounted for 75.4% of the carbon footprint, while only 24.6% for the anaesthesia workstation. On one hand, material production and manufacturing were the most polluting phases of product life cycle which, respectively, represented 71.3% (54.8 kg of CO2-e) and 17.0% (13.1 kg of CO2-e) of total pollution. On the other hand, transport contributed in 10.6% (8.1 kg of CO2-e), while product use resulted in 1.1% (0.9 kg of CO2-e) of GHG production. Electrophysiology catheters were demonstrated to be the main contributors of environmental impact with 29.9 kg of CO2-e (i.e. 38.8%). Three dimensional mapping system and electrocardiogram patches were accounting for 6.8 kg of CO2-e (i.e. 8.8% of total). CONCLUSION AF catheter ablation involves a mean of 76.9 kg of CO2-e. With an estimated 600 000 annual worldwide procedures, the environmental impact of AF catheter ablation activity is estimated equal to 125 tons of CO2 emission each day. It represents an equivalent of 700 000 km of car ride every day. Electrophysiology catheters and patches are the main contributors of the carbon footprint. The focus must be on reducing, reusing, and recycling these items to limit the impact of AF ablation on the environment. A road map of steps to implement in different time frames is proposed.
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Affiliation(s)
- Geoffroy Ditac
- Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
| | - Pierre-Jean Cottinet
- INSA-Lyon, LGEF, Université de Lyon, 20 Av. Albert Einstein, 69100 Villeurbanne, France
| | - Minh Quyen Le
- INSA-Lyon, LGEF, Université de Lyon, 20 Av. Albert Einstein, 69100 Villeurbanne, France
| | - Daniel Grinberg
- Department of Cardiac Surgery, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
- Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 8 avenue Rockefeller, 69003 Lyon, France
| | - Josselin Duchateau
- Department of electrophysiology, CHU Bordeaux, Université de Bordeaux, IHU LIRYC, Av. du Haut Lévêque, 33600 Pessac, France
| | - Kévin Gardey
- Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
| | - Arnaud Dulac
- Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
| | - Antoine Delinière
- Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
- Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 8 avenue Rockefeller, 69003 Lyon, France
| | - Christelle Haddad
- Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
| | - Julie Boussuge-Roze
- Department of electrophysiology, CHU Bordeaux, Université de Bordeaux, IHU LIRYC, Av. du Haut Lévêque, 33600 Pessac, France
| | - Frédéric Sacher
- Department of electrophysiology, CHU Bordeaux, Université de Bordeaux, IHU LIRYC, Av. du Haut Lévêque, 33600 Pessac, France
| | - Pierre Jaïs
- Department of electrophysiology, CHU Bordeaux, Université de Bordeaux, IHU LIRYC, Av. du Haut Lévêque, 33600 Pessac, France
| | - Philippe Chevalier
- Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
- Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 8 avenue Rockefeller, 69003 Lyon, France
| | - Francis Bessière
- Department of Electrophysiology, Hôpital Cardiologique Louis Pradel, Hospices Civils de Lyon, 28 avenue du Doyen Lepine, 69500 Bron, France
- Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, 8 avenue Rockefeller, 69003 Lyon, France
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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)]. Klin Monbl Augenheilkd 2023; 240:198-217. [PMID: 36812927 DOI: 10.1055/a-2015-1562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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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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Zhang D, Dyer GSM, Blazar P, Earp BE. The Environmental Impact of Open Versus Endoscopic Carpal Tunnel Release. J Hand Surg Am 2023; 48:46-52. [PMID: 35123818 DOI: 10.1016/j.jhsa.2021.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 10/19/2021] [Accepted: 12/01/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The environmental impact of common ambulatory hand surgeries has been an area of growing interest in recent years. There were 2 objectives of this study: (1) to quantify the carbon footprint of carpal tunnel surgery and its principal driving components; and (2) to compare the carbon footprints of open carpal tunnel release (oCTR) and endoscopic carpal tunnel release (eCTR). METHODS We performed a life cycle assessment to quantify the environmental impacts of 2 surgical procedures: oCTR and eCTR. Patients were retrospectively identified by querying the Mass General Brigham institutional billing database. Fourteen oCTR procedures and 14 eCTR procedures in 28 patients were included in the life cycle assessment. The boundaries of the life cycle assessment were the start and end times of the procedures. The environmental impacts were estimated using the carbon footprint, expressed in the equivalent mass of carbon dioxide released into the atmosphere (kgCO2-eq). The facility-related, processing-related, solid waste-related, and total kgCO2-eq were calculated. RESULTS The average carbon footprint of carpal tunnel release was 83.1 kgCO2-eq and was dominated by processing-related and facilities-related factors. The average carbon footprint of eCTR (106.5 kgCO2-eq) was significantly greater than that of oCTR (59.6 kgCO2-eq). CONCLUSIONS Endoscopic carpal tunnel release leaves a greater carbon footprint than oCTR, and its environmental impact is dominated by facility-related and central processing-related factors. TYPE OF STUDY/LEVEL OF EVIDENCE Economic and Decision Analyses IV.
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Affiliation(s)
- Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| | - George S M Dyer
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Philip Blazar
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Brandon E Earp
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA
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Abstract
PURPOSE OF REVIEW The aim of this study was to present an overview of recent publications and opinions in the field of same-day bilateral cataract surgery. RECENT FINDINGS A Cochrane review was published comparing immediate sequential bilateral cataract surgery (ISBCS) and delayed sequential bilateral cataract surgery (DSBCS) with regard to safety outcomes, costs and cost-effectiveness. In addition, several large database studies provided more information on incidences of rare complications such as unilateral and bilateral endophthalmitis rates. SUMMARY Recently available evidence showed that ISBCS is an effective and cost-effective alternative to DSBCS. Nonetheless, additional (randomized) registry studies, randomized controlled trials and cost-effectiveness studies are needed to evaluate bilateral endophthalmitis rates, refractive outcomes and cost-effectiveness of ISBCS compared with DSBCS.
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Affiliation(s)
- Lindsay S Spekreijse
- Maastricht University Medical Center+, University Eye Clinic Maastricht, Maastricht, the Netherlands
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Affiliation(s)
- Jesse Gale
- Surgery & Anaesthesia, University of Otago Wellington, Wellington, New Zealand
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Cunha MF, Pellino G. Environmental effects of surgical procedures and strategies for sustainable surgery. Nat Rev Gastroenterol Hepatol 2022; 20:399-410. [PMID: 36481812 PMCID: PMC9735025 DOI: 10.1038/s41575-022-00716-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2022] [Indexed: 12/13/2022]
Abstract
There is a bidirectional relationship between climate change and health care. Climate change threatens public health, and health care contributes to climate change. For example, surgery is the most energy-intensive practice in the health-care sector, and gastrointestinal conditions are responsible for a substantial environmental burden. However, environmental costs associated with health care are often overlooked. This issue has been examined more closely in current times. Emerging data are mainly focused on surgery, as the most resource-intensive practice. However, there is still a lack of global awareness and guidance on sustainable surgical practices. This Perspective aims to reassess the evidence on health care and surgery carbon footprints, focusing on gastrointestinal conditions, identify issues that need to be addressed to achieve a more sustainable practice and develop perspectives for future surgical procedures. The proposed framework to mitigate the environmental effects of surgery could be translated to other health-care sectors.
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Affiliation(s)
- Miguel F. Cunha
- grid.7157.40000 0000 9693 350XColorectal Surgery group - General Surgery Department, Algarve University Centre, Portimão, Portugal ,Algarve Biomedical Centre, Portimão, Portugal
| | - Gianluca Pellino
- grid.9841.40000 0001 2200 8888Department of Advanced Medical and Surgical Sciences, Universitá degli Studi della Campania ‘Luigi Vanvitelli’, Naples, Italy ,grid.411083.f0000 0001 0675 8654Colorectal Surgery, Vall d’Hebron University Hospital, Barcelona, Spain
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Drew J, Christie SD, Rainham D, Rizan C. HealthcareLCA: an open-access living database of health-care environmental impact assessments. Lancet Planet Health 2022; 6:e1000-e1012. [PMID: 36495883 DOI: 10.1016/s2542-5196(22)00257-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 08/17/2022] [Accepted: 10/18/2022] [Indexed: 06/17/2023]
Abstract
Anthropogenic environmental change negatively effects human health and is increasing health-care system demand. Paradoxically, the provision of health care, which itself is a substantial contributor to environmental degradation, is compounding this problem. There is increasing willingness to transition towards sustainable health-care systems globally and ensuring that strategy and action are informed by best available evidence is imperative. In this Personal View, we present an interactive, open-access database designed to support this effort. Functioning as a living repository of environmental impact assessments within health care, the HealthcareLCA database collates 152 studies, predominantly peer-reviewed journal articles, into one centralised and publicly accessible location, providing impact estimates (currently totalling 3671 numerical values) across 1288 health-care products and processes. The database brings together research generated over the past two decades and indicates exponential field growth.
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Affiliation(s)
- Jonathan Drew
- Department of Surgery (Neurosurgery), Dalhousie University, Halifax, NS, Canada.
| | - Sean D Christie
- Department of Surgery (Neurosurgery), Dalhousie University, Halifax, NS, Canada
| | - Daniel Rainham
- School of Health and Human Performance and the Healthy Populations Institute, Dalhousie University, Halifax, NS, Canada
| | - Chantelle Rizan
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK; Brighton and Sussex Medical School, Brighton, UK
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McKenzie BJ, Haas R, Ferreira GE, Maher CG, Buchbinder R. The environmental impact of health care for musculoskeletal conditions: A scoping review. PLoS One 2022; 17:e0276685. [PMID: 36441677 PMCID: PMC9704655 DOI: 10.1371/journal.pone.0276685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Health care has significant environmental impact. We performed a scoping review to map what is known about the environmental impact of health care for musculoskeletal conditions. METHODS We included published papers of any design that measured or discussed environmental impact of health care or health support services for any musculoskeletal condition in terms of climate change or global warming (e.g., greenhouse gas emissions it produces). We searched MEDLINE and Embase from inception to 2 May 2022 using keywords for environmental health and musculoskeletal conditions, and performed keyword searches using Google and Google Scholar. Two independent reviewers screened studies. One author independently charted data, verified by a second author. A narrative synthesis was performed. RESULTS Of 12,302 publications screened and 73 identified from other searches, 122 full-text articles were assessed for eligibility, and 49 were included (published 1994 to 2022). Of 24 original research studies, 11 measured environmental impact relating to climate change in orthopaedics (n = 10), and medical aids for the knee (n = 1), one measured energy expenditure of laminar versus turbulent airflow ventilation systems in operating rooms during simulated hip replacements and 12 measured waste associated with orthopaedic surgery but did not relate waste to greenhouse gas emissions or environmental effects. Twenty-one editorials described a need to reduce environmental impact of orthopaedic surgery (n = 9), physiotherapy (n = 9), podiatry (n = 2) or occupational therapy (n = 1). Four narrative reviews discussed sustainability relating to hand surgery (n = 2), orthopaedic surgery (n = 1) and orthopaedic implants (n = 1). CONCLUSION Despite an established link between health care and greenhouse gas emissions we found limited empirical data estimating the impact of musculoskeletal health care on the environment. These data are needed to determine whether actions to lower the carbon footprint of musculoskeletal health care should be a priority and to identify those aspects of care that should be prioritised.
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Affiliation(s)
- Bayden J. McKenzie
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Australia
- * E-mail:
| | - Romi Haas
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Australia
| | - Giovanni E. Ferreira
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Chris G. Maher
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Australia
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Ayres BD, Gupta OP, Davis JS, Hahn R, Hsiao CW, Kara R, Di Simplicio S. Economic Impact Analysis of Custom Pak® on Cataract and Vitreoretinal Surgery in the United States. CLINICOECONOMICS AND OUTCOMES RESEARCH 2022; 14:715-730. [DOI: 10.2147/ceor.s382188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 10/28/2022] [Indexed: 11/11/2022] Open
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Schmidt L, Bohnet-Joschko S. Planetary Health and Hospitals' Contribution-A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192013536. [PMID: 36294116 PMCID: PMC9603437 DOI: 10.3390/ijerph192013536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/07/2022] [Accepted: 10/17/2022] [Indexed: 05/28/2023]
Abstract
Climate change is one of the greatest global threats for planetary and human health. This leads to new challenges for public health. Hospitals emit large amounts of greenhouse gases (GHG) in their healthcare delivery through transportation, waste and other resources and are considered as key players in reducing healthcare's environmental footprint. The aim of this scoping review is to provide the state of research on hospitals' carbon footprint and to determine their contribution to mitigating emissions. We conducted a systematic literature search in three databases for studies related to measurement and actions to reduce GHG emissions in hospitals. We identified 21 studies, the oldest being published in 2012, and the most recent study in 2021. Eight studies focused on GHG emissions hospital-wide, while thirteen studies addressed hospital-based departments. Climate actions in the areas of waste and transportation lead to significant reductions in GHG emissions. Digital transformation is a key factor in implementing climate actions and promoting equity in healthcare. The increasing number of studies published over time indicates the importance of the topic. The results suggest a need for standardization of measurement and performance indicators on climate actions to mitigate GHG emissions.
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Dokal K, Morris M, Spooner R, Perkins P. The carbon footprint of a hospice. BMJ Support Palliat Care 2022:spcare-2022-003972. [PMID: 36207062 DOI: 10.1136/spcare-2022-003972] [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: 09/08/2022] [Accepted: 09/21/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Environmental sustainability is an important concern within the National Health Service. Compared with other specialties, there has been little research within palliative care. This study aims to calculate the carbon footprint of a specialist palliative care unit. METHODS Resources grouped into medical, non-medical, travel, energy and waste were collected for the year 2021 in a hospice in the South West of England. Following a top-down approach, the activity used for each resource was multiplied by an emissions factor to calculate the carbon footprint. Staff attitudes were also surveyed. RESULTS The hospice carbon footprint was calculated as 420 tonnes kgCO2e. Travel (35%) was the highest contributor to emissions followed by gas (33%) and non-medical supplies (17%). There were 95 responses to the staff survey (59% response rate) with strong enthusiasm towards sustainable practices. CONCLUSION This is the first study to estimate the carbon footprint of a specialist palliative care unit. Compared with other specialties, palliative care has relatively low greenhouse gas emissions. Identifying sources of carbon equivalent production can be a first step into developing interventions to reduce this use. Our carbon footprint study will be used by the Hospice Sustainability Group to reduce our unit's carbon footprint.
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Affiliation(s)
- Kitt Dokal
- Faculty of Life Science and Medicine, King's College London GKT School of Medical Education, London, UK
| | - Mungo Morris
- Aspen Medical Practice, Gloucester, UK
- Sue Ryder Leckhampton Court Hospice, Cheltenham, UK
| | - Rosie Spooner
- Education Department, Centre for Sustainable Healthcare, Oxford, UK
- Paediatrics, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
| | - Paul Perkins
- Sue Ryder Leckhampton Court Hospice, Cheltenham, UK
- Palliative Medicine, Gloucestershire Hospitals NHS Foundation Trust, Cheltenham, UK
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Muacevic A, Adler JR. The Role and Duty of Global Surgery in Increasing Sustainability and Improving Patient Care in Low and Middle-Income Countries. Cureus 2022; 14:e30023. [PMID: 36381932 PMCID: PMC9637440 DOI: 10.7759/cureus.30023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2022] [Indexed: 01/25/2023] Open
Abstract
Global health is one of the most pressing issues facing the 21st century. Surgery is a resource and energy-intensive healthcare activity which produces overwhelming quantities of waste. Using the 5Rs (Reduce, Reuse, Recycle, Rethink, and Research) provides the global surgical community with the pillars of sustainability to develop strategies that are scalable and transferable in both low and middle-income countries and their high-income counterparts. Reducing energy consumption is necessary to achieving net zero emissions in the provision of essential healthcare. Simple, easily transferrable, high-income country (HIC) technologies can greatly reduce energy demands in low-income countries. Reusing appropriately sterilized equipment and reprocessing surgical devices leads to a reduction of costs and a significant reduction of unnecessary potentially hazardous waste. Recycling through official government-facilitated means reduces 'informal recycling' schemes, and the spread of communicable diseases whilst expectantly reducing the release of carcinogens and atmospheric greenhouse gases. Rethinking local surgical innovation and providing an ecosystem that is both ethical and sustainable, is not only beneficial from a medical perspective but allows local financial investment and feeds back into local economies. Finally, research output from low-income countries is minimal compared to the global academic output. Research from low and middle-income countries must equal research from high-income countries, thereby producing fruitful partnerships. With adequate international collaboration and awareness of the lack of necessary surgical interventions in low and middle-income countries (LMICs), global surgery has the potential to reduce the impact of surgical practice on the environment, without compromising patient safety or quality of care.
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Bolten A, Kringos DS, Spijkerman IJB, Sperna Weiland NH. The carbon footprint of the operating room related to infection prevention measures: a scoping review. J Hosp Infect 2022; 128:64-73. [PMID: 35850380 DOI: 10.1016/j.jhin.2022.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/04/2022] [Accepted: 07/06/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Infection prevention measures are widely used in operating rooms (ORs). However, the extent to which they are at odds with ambitions to reduce the health sector's carbon footprint remains unclear. AIM To synthesize the evidence base for the carbon footprint of commonly used infection prevention measures in the OR, namely medical devices and instruments, surgical attire and air treatment systems. METHODS A scoping review of the international scientific literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search was performed in PubMed and Google Scholar. Articles published between 2010 and June 2021 on infection prevention measures, their impact on the health sector's carbon footprint, and risk for surgical site infections (SSIs) were included. FINDINGS Although hospitals strive to reduce their carbon footprint, many infection prevention measures result in increased emissions. Evidence suggests that the use of disposable items instead of reusable items generally increases the carbon footprint, depending on sources of electricity. Controversy exists regarding the correlation between air treatment systems, contamination and the incidence of SSIs. The literature indicates that new air treatment systems consume more energy and do not necessarily reduce SSIs compared with conventional systems. CONCLUSION Infection prevention measures in ORs can be at odds with sustainability. The use of new air treatment systems and disposable items generally leads to significant greenhouse gas emissions, and does not necessarily reduce the incidence of SSIs. Alternative infection prevention measures with less environmental impact are available. Implementation could be facilitated by embracing environmental impact as an additional dimension of quality of care, which should change current risk-based approaches for the prevention of SSIs.
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Affiliation(s)
- A Bolten
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - D S Kringos
- Department of Public and Occupational Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - I J B Spijkerman
- Department of Microbiology and Infection Prevention, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - N H Sperna Weiland
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands; Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
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Ji L, Wang Y, Xie Y, Xu M, Cai Y, Fu S, Ma L, Su X. Potential Life-Cycle Environmental Impacts of the COVID-19 Nucleic Acid Test. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:13398-13407. [PMID: 36053337 PMCID: PMC9469759 DOI: 10.1021/acs.est.2c04039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Revised: 08/21/2022] [Accepted: 08/22/2022] [Indexed: 05/10/2023]
Abstract
Massive diagnostic testing has been performed for appropriate screening and identification of COVID-19 cases in the ongoing global pandemic. However, the environmental impacts of COVID-19 diagnostics have been least considered. In this paper, the environmental impacts of the COVID-19 nucleic acid diagnostics were assessed by following a full cradle-to-grave life-cycle approach. The corresponding life-cycle anthology was established to provide quantitative analysis. Moreover, three alternative scenarios, i.e., material substitution, improved waste treatment, and electric vehicle (EV)-based transportation, were further proposed to discuss the potential environmental mitigation and conservation strategies. It was estimated that the life cycle of a single COVID-19 nucleic acid diagnostic test in China would lead to the emission of 612.9 g CO2 equiv global warming potential. Waste treatment, as a step of life cycle, worsen the environmental impacts such as global warming potential, eutrophication, and ecotoxicity. Meanwhile, diesel-driven transportation was considered as the major contributor to particulate air. Even though COVID-19 diagnostics are of the greatest importance to end the pandemic, their environmental impacts should not be ignored. It is suggested that improved approaches for waste treatment, low-carbon transportation, and a reliable pool sampling strategy are critical for the achievement of sustainable and green diagnostics.
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Affiliation(s)
- Ling Ji
- School
of Economics and Management, Beijing University
of Technology, Beijing 100124, China
| | - Yongyang Wang
- Institute
of Environmental and Ecological Engineering, Guangdong University of Technology, Guangzhou, Guangdong 510006, China
| | - Yulei Xie
- Institute
of Environmental and Ecological Engineering, Guangdong University of Technology, Guangzhou, Guangdong 510006, China
| | - Ming Xu
- School
for Environment and Sustainability, University
of Michigan, Ann Arbor, Michigan 48109, United States
- Department
of Civil and Environmental Engineering, University of Michigan, Ann Arbor, Michigan 48109, United States
| | - Yanpeng Cai
- Institute
of Environmental and Ecological Engineering, Guangdong University of Technology, Guangzhou, Guangdong 510006, China
| | - Shengnan Fu
- College
of Life Science and Technology, Beijing
University of Chemical Technology, Beijing 100029, China
| | - Liang Ma
- China-Japan
Friendship Hospital, Beijing 100029, China
| | - Xin Su
- College
of Life Science and Technology, Beijing
University of Chemical Technology, Beijing 100029, China
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Palmer DJ, Robin AL, McCabe CM, Chang DF. Reducing topical drug waste in ophthalmic surgery: multisociety position paper. J Cataract Refract Surg 2022; 48:1073-1077. [PMID: 35608314 DOI: 10.1097/j.jcrs.0000000000000975] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022]
Abstract
This position article on reducing topical drug waste with ophthalmic surgery was written by the Ophthalmic Instrument Cleaning and Sterilization Task Force, comprising representatives of the ASCRS, American Academy of Ophthalmology, American Glaucoma Society, and Outpatient Ophthalmic Surgery Society. Drug waste significantly increases the costs and carbon footprint of ophthalmic surgery. Surgical facilities should be permitted to use topical drugs in multidose containers on multiple patients until the manufacturer's labeled date of expiration, if proper guidelines are followed. Surgical patients requiring a topical medication not used for other patients should be allowed to bring that partially used medication home for postoperative use. These recommendations are based on published evidence and clarification of policies from multiple regulatory and accrediting agencies with jurisdiction over surgical facilities. Surveys suggest that most ambulatory surgery centers and hospitals performing cataract surgery are wasting topical drugs unnecessarily.
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Affiliation(s)
- David J Palmer
- From the Northwestern University Feinberg School of Medicine, Chicago, Illinois (Palmer); University of Michigan, Ann Arbor, Michigan (Robin); The Eye Associates, Bradenton, Florida (McCabe); Altos Eye Physicians, Los Altos, California (Chang)
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Transconjunctival XEN45 Implantation for Glaucoma Performed at the Slit Lamp: A Pilot Study. J Glaucoma 2022; 31:675-681. [PMID: 35773233 PMCID: PMC9362344 DOI: 10.1097/ijg.0000000000002070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/12/2022] [Indexed: 02/04/2023]
Abstract
PRCIS This pilot study of ab externo implantation of a gel microstent is a novel, minimally invasive glaucoma surgery performed at the slit lamp that is effective for lowering intraocular pressure in patients with uncontrolled glaucoma. PURPOSE To evaluate the intraocular pressure (IOP)-lowering effect of gel microstent (XEN Gel Stent, Allergan, Irvine, CA) implantation using an ab externo approach in an office setting. PATIENTS AND METHODS This retrospective, multicenter chart review examined outcomes in patients with uncontrolled glaucoma receiving maximally tolerated medical therapy, who underwent slit lamp ab externo gel stent implantation. At postoperative visit, the IOP, the number of glaucoma medications, the final position of the stent, and the needling rate were analyzed. Assessments were conducted 1 day, 1 week and 1, 3, 6, and 12 months after the implantation. Treatment success was defined as IOP ≥6 mm Hg and ≤18 mm Hg with ≥20% reduction from presurgical IOP, with or without medications. RESULTS Thirty-four eyes from 28 patients were included. Mean preoperative IOP was 24.1±8.0 mm Hg on 3.2±0.9 glaucoma medications. At 12 months postoperative, IOP was reduced to 15.4±4.7 mm Hg on 0.6±1.0 medications; 46.9% and 81.3% of eyes achieved complete and partial success, respectively. The gel stent was properly positioned in 94.1% of eyes after 1 attempt at implantation and in 100% of eyes after a second attempt. In addition to malpositioning, observed complications included occlusion, erosion, and endophthalmitis following anterior chamber reformation. Adjunctive needling was required in 21% of implanted eyes. CONCLUSION Slit-lamp-based transconjunctival XEN45 implantation reduced intraocular pressure in glaucoma patients in the first year of this pilot study and was most commonly associated with wound leak and hypotony among other adverse events.
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50
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Potential Cost Savings Associated with a Multiuse Preoperative and Preinjection Eyedrop Protocol. Ophthalmology 2022; 129:1305-1312. [PMID: 35772659 DOI: 10.1016/j.ophtha.2022.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/15/2022] [Accepted: 06/22/2022] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Calculate the cost savings associated with a multiuse preoperative and preinjection eyedrop protocol. DESIGN Economic analysis PARTICIPANTS: Adults undergoing ophthalmic surgical procedures requiring preoperative dilation and intravitreal injections. METHODS Economic modeling with scenario analysis was used to derive the value for cost-savings attributable to a protocol where perioperative mydriatic eyedrop bottles are used across multiple patients versus the current protocol where drop bottles are wasted after single patient use. Similar analyses were performed for a multiuse povidone-iodine protocol for intravitreal injections. Sensitivity analyses were used to test baseline model assumptions with varying degrees of waste and patient volume. RESULTS The multi-use mydriatic protocol allowed for a 97.1% reduction in the number of eyedrop bottles required for the single-use protocol (1037 bottles vs. 35850 bottles). This led to an estimated five year cost savings of approximately $240,000 (nominal) per institution (performing an average of 1434 cases/year) in the base case. This savings varied minimally in sensitivity analyses accounting for practical limitations (loss, expiration, or contamination) of multi-use containers, with savings of 97.54-95.00% for excess supply ranges from 0%-100% in the multiuse protocol. Likewise, the cost savings varied minimally in sensitivity analyses for eye drop sizes, with savings of 99.23-96.69% for mydriatic eye drop sizes of 15 microliter per drop to 65 microliter per drop, respectively, in the multi-use protocol. Over a five-year period, for povidone-iodine drops prior to performing intravitreal injection, the multi-use protocol required 153 bottles compared to 41,954 bottles (99.6% reduction) for the current single-use protocol, resulting in a nominal cost savings of $41,801, which varied minimally in sensitivity analyses. CONCLUSIONS Multiuse perioperative mydriatic eyedrops are a viable option for cost and environmental waste reduction for ophthalmologic procedures and surgeries requiring dilation. Likewise, multiuse povidone-iodine may allow for large relative cost reduction for in office procedures. The total potential savings over five years was estimated greater than $280,000 before adjusting for inflation.
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