Knee replacement surgery has the highest carbon footprint of the five most common surgeries performed by the NHS, found a recent study, which also recommended that reusable single-use items – like theatre table drapes and surgical gowns –would reduce carbon emissions in surgical operations.
The analysis, published in the Journal of the Royal Society of Medicine, showed that 68% of the carbon contributions are from single-use items and their production and disposal, along with the processes for decontaminating reusable products.
The study was conducted by researchers from Brighton and Sussex Medical School and the University of Warwick – the first systematic evaluation of the carbon footprint of products used in common surgical operations. The analysis was conducted through direct observation of operating rooms at three sites of the University Hospitals Sussex NHS Foundation Trust.
The researchers utilised the carbon dioxide equivalent (CO2e), which is the standard unit for measuring carbon footprints, to quantify the carbon footprint of each procedure.
The results revealed that knee replacement surgery had the highest product carbon footprint at 85.5kg CO2e, followed by gall bladder removal at 20.3kg CO2e, carpal tunnel decompression surgery at 12.0kg CO2e, hernia repair at 11.7kg CO2e, and tonsillectomy at 7.5kg CO2e.
These findings highlight the varying levels of carbon emissions associated with different procedures.
The researchers said a small percentage of products – only 23% of the total – was responsible for more than 80% of the product carbon footprint.
This suggests that efforts to reduce greenhouse gas emissions from operations should prioritise strategies targeting these specific products, typically large single-use items, often made of plastic.
Dr Chantelle Rizan, lead researcher and clinical lecturer in Sustainable Healthcare at Brighton and Sussex Medical School, emphasised the significance of mitigating the carbon footprint of products used in operating theatres as part of achieving net zero carbon healthcare.
She said strategies should focus on eliminating or finding low carbon alternatives for products with the highest contribution to carbon emissions.
The researchers propose several strategies, which include avoiding unnecessary use of non-sterile gloves by promoting hand-washing as an alternative, opening gauze swab packs only when necessary, and working with suppliers to remove rarely used items from single-use pre-prepared packs.
Additionally, the researchers suggest that reusable alternatives should be considered for single-use high carbon products, such as gowns, curtains, and instrument table drapes. They said there is no evidence to suggest reusable surgical textiles are clinically inferior, and these reusable options can significantly reduce surgeries’ carbon footprint.
It was possible, they said, to adopt sustainable alternatives without compromising patient care.
Study details
The carbon footprint of products used in five common surgical operations: identifying contributing products and processes
Chantelle Rizan, Robert Lillywhite, Mahmood F Bhutta et al.
Published in the Journal of the Royal Society of Medicine on 13 April 2023
Abstract
Objectives
Mitigating carbon footprint of products used in resource-intensive areas such as surgical operating rooms will be important in achieving net zero carbon healthcare. The aim of this study was to evaluate the carbon footprint of products used within five common operations, and to identify the biggest contributors (hotspots).
Design
A predominantly process-based carbon footprint analysis was conducted for products used in the five highest volume surgical operations performed in the National Health System in England.
Setting
The carbon footprint inventory was based on direct observation of 6–10 operations/type, conducted across three sites within one NHS Foundation Trust in England.
Participants
Patients undergoing primary elective carpal tunnel decompression, inguinal hernia repair, knee arthroplasty, laparoscopic cholecystectomy, tonsillectomy (March 2019 – January 2020).
Main outcome measures
We determined the carbon footprint of the products used in each of the five operations, alongside greatest contributors through analysis of individual products and of underpinning processes.
Results
The mean average carbon footprint of products used for carpal tunnel decompression was 12.0 kg CO2e (carbon dioxide equivalents); 11.7 kg CO2e for inguinal hernia repair; 85.5 kg CO2e for knee arthroplasty; 20.3 kg CO2e for laparoscopic cholecystectomy; and 7.5 kg CO2e for tonsillectomy. Across the five operations, 23% of product types were responsible for ≥80% of the operation carbon footprint. Products with greatest carbon contribution for each operation type were the single-use hand drape (carpal tunnel decompression), single-use surgical gown (inguinal hernia repair), bone cement mix (knee arthroplasty), single-use clip applier (laparoscopic cholecystectomy) and single-use table drape (tonsillectomy). Mean average contribution from production of single-use items was 54%, decontamination of reusables 20%, waste disposal of single-use items 8%, production of packaging for single-use items 6% and linen laundering 6%.
Conclusions
Change in practice and policy should be targeted towards those products making greatest contribution, and should include reducing single-use items and switching to reusables, alongside optimising processes for decontamination and waste disposal, modelled to reduce carbon footprint of these operations by 23%–42%.
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