Conference report: Research for Greener Surgery 2024 at the University of Birmingham

Purpose: The Research for Greener Surgery Conference took place at the University of Birmingham on 17 December 2024. This was attended by 382 delegates in-person and over 350 virtually. The Conference aimed to build on the existing knowledge on research in sustainability and to provide updates on the ongoing body of research funded by the NIHR to create environmentally sustainable operating theatres in the NHS. The aim was also to promote local initiatives taking place in different NHS trusts and encourage collaboration and upscaling.

Insights from 2024: Following an opening session from Professor Aneel Bhangu, co-director of the Green Surgery Unit, and Professor Adam Tickell, vice-Chancellor of the University of Birmingham, updates from the last year of activity in sustainable surgery were provided from a wide range of experts in the field. These included Natalia Kurek (Greener NHS), Hugh Montgomery (Lancet Countdown on health and climate change), Liza Jabbour (Birmingham Institute for Sustainability & Climate Action) and Jasmine Winter-Beatty (Imperial College London). Results were shared from the completion of the Cheetah trial carbon model, which showed that the trial intervention, previously proven to be clinically beneficial and cost-effective, also leads to carbon savings. The evaluation of this triad of outcomes (clinical, cost and carbon) will support the adoption of the intervention in clinical practice worldwide.

Randomised cluster trials: Progress made on the DRAGON (Reusable versus disposable drapes and gowns for greener operating theatres) trial recruitment was then presented, which led to a discussion on the practical aspects of implementation of the trial results within the NHS. The trial is currently recruiting in the UK. A new anaesthesia-centred trial was introduced, the NOBLE trial, which focusses on the delivery of nitrous oxide to patients through cylinders and manifolds. Expressions of interest are currently being collected for NOBLE.

The anaesthesia session also provided insights for the global needs assessment, which aims to gain an understanding of anaesthesia practices worldwide, and how these could be made more sustainable.

Energy- UK and global: Two expert panels focused on clean energy provision to hospitals in the UK and globally, highlighting the crucial need for clean, reliable energy in hospitals worldwide. This will ensure not only the provision of safe surgical care, but the delivery of maternal care and vaccinations, and be beneficial to the local communities. Adewale Adisa (Obafemi Awolowo University, Nigeria) launched the 100-4-100 project, which aims to implement and evaluate clean energy strategies for 100 major hospitals in low resource settings. Pilot sites in India and Nigeria have been identified and are now ready to launch.

Beyond surgery: Other sessions explored sustainability beyond the operating theatres, including within the wider hospital setting and primary care. A behavioural change session focussed on the basic principles of behavioural change science and their healthcare-related implementation. A session on plastic focused on its important role within the hospital, and explored with the audience possible areas and opportunities for improvement. A fireside chat provided insights on the similar challenges faced by primary and secondary care when implementing sustainability in practice, and highlighted a potential new avenue for collaboration.

Time for change: To close the Conference, Professor Aneel Bhangu summarised the following key messages which emerged from the meeting:

Professor Bhangu highlighted the need to reconvene in 2025 to keep building momentum for sustainable change, and to share progress and impact made through local and national initiatives. Recordings of key sessions will soon be available from the BJS Academy.