The carbon footprint of surgical operations: a systematic review update

INTRODUCTION

Sustainability in healthcare is a rapidly developing area of research with recent formal recognition from institutions around the world. We completed an update of a systematic review published in 2020. The aims of this review were to determine the reported carbon footprints of surgical operations in hospitals worldwide, identify variations in reported carbon footprints and highlight carbon hotspots associated with surgery.

METHODS

A systematic review was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. The MEDLINE®, Embase® and Cochrane Library databases were searched, and eligibility criteria applied. The study characteristics, scope of product inventory and results were extracted and synthesised. A quality assessment of each study was completed to inform the reliability of the research.

RESULTS

1,308 articles were identified and 7 met the inclusion criteria for the review. The carbon footprint ranged from 28.49kg to 505.1kg carbon dioxide equivalents (CO2e). Medical devices and consumables were the greatest contributor to emissions, with material production and manufacture representing the majority of this carbon hotspot. There were significant methodological limitations and a lack of consistency in carbon footprint calculations between studies.

CONCLUSIONS

This systematic review identifies medical devices and consumables as the largest carbon hotspot where healthcare providers should target their sustainability initiatives. Nevertheless, the number of studies was limited and the quality of the evidence was weak. We recommend that researchers in healthcare sustainability develop international standards for conducting and reporting such studies. This would allow for comparison of individual studies and facilitate meta-analysis of cumulative evidence. A reliable evidence base is a prerequisite for identifying optimal interventions to ensure societal benefits.

Choosing the best method to utilise single positron emission computed tomography (SPECT) scans in the management of unilateral condylar hyperplasia

Facial asymmetry secondary to unilateral condylar hyperplasia can be a diagnostic challenge to oral and maxillofacial surgeons. Single positron emission computed tomography (SPECT) scans provide a useful adjunct. We report a brief summary of the evidence describing the effectiveness of different methods of analysing SPECT scans and compare it with the results of a 10-year study at Sunderland Royal Hospital. Overall, both the evidence base and our study strongly favour use of the condyle:condyle ratio over the condyle:reference bone ratio, suggesting that no further comparisons are needed.

Parkinson's Disease, Depression, and Quality-of-Life

BACKGROUND

Depression is the most common psychiatric disorder associated with Parkinson's disease (PD) but is often under diagnosed and under treated leading to worsening of symptoms and deterioration of the quality-of-life of the people suffering from this disease.

AIMS

The current study aims to determine the correlation between depression and health-related quality-of-life (HRQOL) domains in patients with PD.

MATERIALS AND METHODS

A sample of 65 consecutive patients attending the specialty Parkinson's clinic was assessed by a psychiatrist as part of the treatment protocol. Diagnosis of depression was done using the International Classification of Diseases-10 by a psychiatrist and depression was scored using the Geriatric Depression Scale (GDS). QOL-BREF Malayalam version was used to assess quality-of-life in the patients.

STATISTICAL ANALYSIS

One-way ANOVA was used to find the difference in the quality-of-life experienced by different age categories, duration of the disease, psychiatric co-morbidity. Independent sample t-test was used to find the difference in the quality-of-life experienced by genders, co morbid conditions and to find the difference in the scores on GDS and domains of WHO QOL BREF. Association of H and Y staging and duration of Parkinsonism with GDS Scores were computed using Pearson's Chi-square test.

RESULTS AND CONCLUSIONS

There was a significant association of female gender and depression with the physical and psychological domains of QOL while the duration and staging of PD did not have any association with QOL Domains. Depression thus emerges as one of the main predictors of poor quality-of-life in PD.

Natural history, trend of prevalence and spectrum of manifestations of Bancroftian filarial disease in Pondicherry (South India)

The study examines the changes in the disease parameters of lymphatic filariasis over a period of time based on three surveys during 1957, 1986 and 1992 in Pondicherry, South India. The overall prevalence of filarial disease in the three surveys was 4.7, 6.7 and 9.9% respectively. It was significantly higher in males (1957:5.3%; 1986:13.7%; 1992:18.8%) when compared to females (1957:3.8%; 1986:2.3%; 1992:2.7%) in all the three surveys (P <0.05). The overall prevalence of acute adenolymphangitis declined from 1.0 in 1957 to 0.2 in 1986 and 0.04% in 1992. While the prevalence of hydrocele showed an increasing trend from 2.7 in 1957 to 11.9 in 1986 and 17.3% in 1992, the prevalence of lymphoedema (1.9 in 1957; 1.9 in 1986 and 1.8% in 1992) was stable over the same period. The prevalence of disease was relatively higher in all age groups of both male and female population in 1992 when compared either to 1957 or 1986. Similarly a monotonic increase in the prevalence of hydrocele was observed in all age groups in 1992 when compared to previous surveys. The implications of the changes in prevalence of the chronic manifestations when compared to the changes in the acute manifestations over a period of 35 years are discussed.