The carbon footprint of products used in five common surgical operations: identifying contributing products and processes

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%.

Keywords: Environmental issues; general surgery; orthopaedic and trauma surgery; otolaryngology; surgery.

Figure 1.

Proportion of products responsible for cumulative carbon footprint for each operation. Cumulative carbon footprint contribution and proportion of product types based on mean across all operations for each operation type. Each data point relates to a single-product type (e.g. suction receptacle). Arrows mark the point at which 80% of carbon footprint reached.