This cutting-edge paper by Ang et al.1 addresses the carbon footprint of surgery for non-melanoma skin cancer (NMSC) surgery at the Welsh Centre for Burns and Plastic Surgery in Swansea, UK. They demonstrated a high carbon footprint from surgery for NSMC, the most common cancer in the UK. Addressing the impact of healthcare facilities on climate change is a key global priority2. An estimated 4-6% of global carbon emissions comes from healthcare3. Within this, surgery is the largest contributor; operating theatres generate 50-70% more waste and use up to 6 times as much energy as other hospital departments4. Reducing healthcare carbon emissions is a priority of the NHS with new initiatives such as the “Greener Operations: Sustainable Perioperative Practice Priority Setting Partnership”5. This article expands on how surgical departments can help decarbonise healthcare.
Measuring the carbon footprint is a fundamental first step. The authors have performed a lifecycle study to assess the carbon footprint of NMSC surgery, estimating average emissions of 29.76 - 34.26kgCO2eq per operation. As NMSC is the most common cancer in the UK, the net carbon emissions from this disease is significant, and this paper forecasts a 25% increase by 2035. Furthermore, this study highlights the difficulties of decarbonising surgery. Operating theatres are energy intensive, using ventilators, medical devices such as diathermy, lights and control of air flow and temperature4. Due to the sterility requirements, there is a high use of single-use surgical consumables. Production, transport and waste disposal of these mostly plastic items contributes to carbon emissions. In comparing direct skin closure to the more complex full-thickness skin graft, the authors have shown how more technical and longer procedures generate higher carbon emissions.
Other studies have also demonstrated high carbon emissions from surgical supplies6,7. Changing to reusable surgical equipment may reduce carbon footprint by 50-97%8. However, further research is needed to fully explore carbon footprint of reusable versus single use surgical items, such as surgical drapes. Carbon models are needed that capture complete healthcare pathways, including the carbon cost of operative complications. The role that hospital energy supply contributes to carbon emissions varies, depending on the source of electricity7-9. Hospitals can reduce their carbon emissions by transitioning to renewable energy, such as solar power. Further carbon foot-printing research is needed, conducted through similarly reproducible life cycle methodology. Carbon foot-printing should be expanded to cover the full pathway including patient transportation, staff commuting, and perioperative care which all add to healthcare-related emissions.
Altogether, this paper adds to a growing body of research in healthcare carbon emissions emphasising the need for the NHS commitment to achieve net zero emissions by 2045. Reducing carbon emissions in healthcare is essential, as climate change is an impending global health catastrophe that needs to be addressed by every profession.
References
Ang K, Jovic M, Malin I, Ali S R, Whitaker S, Whitaker I S, Carbon footprint of non-melanoma skin cancer surgery, BJS Open. DOI: 10.1093/bjsopen/zrae084.
Romanello M, McGushin A, Di Napoli C, Drummond P, Hughes N, Jamart L, et al. The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future. Lancet. 2021;398:1619-62.
Watts N, Amann M, Arnell N, Ayeb-Karlsson S, Beagley J, Belesova K, et al. The 2020 report of The Lancet Countdown on health and climate change: responding to converging crises. Lancet. 2021;397:129-70.
Guetter CR, Williams BJ, Slama E, Arrington A, Henry MC, Möller MG, et al. Greening the operating room. The American Journal of Surgery. 2018;216:683-8.
England. N. Delivering a ‘Net Zero’ National Health Service. 2022. . 2022.
Morris DS, Wright T, Somner JE, Connor A. The carbon footprint of cataract surgery. Eye (Lond). 2013;27:495-501.
Grinberg D, Buzzi R, Pozzi M, Schweizer R, Capsal JF, Thinot B, et al. Eco-audit of conventional heart surgery procedures. Eur J Cardiothorac Surg. 2021;60:1325-31.
Robinson PN, Surendran K, Lim SJ, Robinson M. The carbon footprint of surgical operations: a systematic review update. Ann R Coll Surg Engl. 2023;105:692-708.
Thiel CL, Eckelman M, Guido R, Huddleston M, Landis AE, Sherman J, et al. Environmental impacts of surgical procedures: life cycle assessment of hysterectomy in the United States. Environ Sci Technol. 2015;49:1779-86.
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