USA vs. UK: Sustainable Surgical Practices and Environmental Impact

Sources of Surgical Emissions

• 💡 Anesthetic gases, particularly desflurane, have a high global warming potential, prompting a shift towards local anesthesia or intravenous anesthesia in the UK.
• ⚡ Energy use in operating theaters, primarily from HVAC systems, is a significant contributor; turning off systems when not in use can save substantial carbon.
• 🗑️ Single-use consumables are a major source of waste and emissions, with a push towards reusable drapes, gowns, and instruments.

Healthcare Emissions and Surgeon's Role

• 🌍 The US healthcare industry generates a disproportionately large share of global healthcare emissions, with surgery being a major contributor.
• 💰 US healthcare's fee-for-service model can incentivize more procedures, potentially increasing greenhouse gas emissions.
• ⚠️ Surgeons should care about sustainability because environmental impact affects global health outcomes, worsening conditions like cardiovascular and pulmonary diseases.

Cost-Effectiveness of Sustainability

• 💸 Making surgical practices more sustainable often aligns with cost savings, as reusable items (textiles, instruments) have a lower long-term cost than disposables.
• 📈 While initial investment in reusable equipment may be higher, it leads to long-term savings and increased resilience against supply chain disruptions.
• 🇬🇧 In the UK, hospitals demonstrate cost savings from sustainability projects, reinvesting saved money into further initiatives.

Influencing Industry and Policy

• 🤝 The NHS is pushing industry to comply with net-zero goals for procurement, aiming to incentivize more sustainable equipment manufacturing.
• 🎯 Clinicians have significant power to influence industry by demanding reusable and sustainable devices, though industry often prefers disposable models for recurring revenue.
• 🏥 Policy changes and collaboration between healthcare providers, industry, and government are crucial for aligning priorities towards sustainability.

Domains of Surgical Sustainability

• 🏥 The operational domain focuses on clinical practice, including reducing waste and energy consumption.
• 📚 The educational domain involves teaching medical students and trainees about environmentally friendly surgical practices and behavior change.
• 🔬 The research domain explores the intersection of climate change and surgery, investigating outcomes of reprocessed versus new devices.

Practical Sustainability Initiatives

• 🧤 A campaign to reduce unnecessary use of non-sterile gloves has saved plastic waste and improved patient experience.
• 🛏️ Replacing single-use incopads with reusable pillowcases in laparoscopic surgery is a simple yet effective waste reduction strategy.
• ♻️ Easy initiatives include optimizing HVAC systems, reducing red bag waste, implementing recycling programs, and starting reprocessing programs for instruments.

Future of Sustainable Surgery

• 🌱 The future involves optimizing pre-operative care to reduce complications and the need for surgery, and improving the quality of care to minimize low-value interventions.
• 🤝 Building a culture of sustainability through champions, collaboration, and societal initiatives is key to long-term change.
• 🚀 Continued efforts in reducing greenhouse gas emissions, working with industry, and developing policy will drive progress in sustainable surgical care.