Perspectives on sustainability among surgeons: findings from the SAGES-EAES sustainability in surgical practice task force survey

Abstract

Background: Surgical care significantly contributes to healthcare-associated greenhouse gas emissions (GHG). Surgeon attitudes about mitigation of the impact of surgical practice on environmental sustainability remains poorly understood. To better understand surgeon perspectives globally, the Society of American Gastrointestinal and Endoscopic Surgeons and the European Association for Endoscopic Surgery established a joint Sustainability in Surgical Practice (SSP) Task Force and distributed a survey on sustainability.

Methods: Our survey asked about (1) surgeon attitudes toward sustainability, (2) ability to estimate the carbon footprint of surgical procedures and supplies, (3) concerns about the negative impacts of sustainable interventions, (4) willingness to change specific practices, and (5) preferred educational topics and modalities. Questions were primarily written in Likert-scale format. A clustering analysis was performed to determine whether survey respondents could be grouped into distinct subsets to inform future outreach and education efforts.

Results: We received 1024 responses, predominantly from North America and Europe. The study revealed that while 63% of respondents were motivated to enhance the sustainability of their practice, less than 10% could accurately estimate the carbon footprint of surgical activities. Most were not concerned that sustainability efforts would negatively impact their practice and showed readiness to adopt proposed sustainable practices. Online webinars and modules were the preferred educational methods. A clustering analysis identified a group particularly concerned yet willing to adopt sustainable changes.

Conclusion: Surgeons believe that operating room waste is a critical issue and are willing to change practice to improve it. However, there exists a gap in understanding the environmental impact of surgical procedures and supplies, and a sizable minority have some degree of concern about potential adverse consequences of implementing sustainable policies. This study uniquely provides an international, multidisciplinary snapshot of surgeons' attitudes, knowledge, concerns, willingness, and preferred educational modalities related to mitigating the environmental impact of surgical practice.

Keywords: Carbon footprint; Climate change; Decarbonization; Minimally invasive surgery; Operating room waste; Sustainability.

Fig. 1

Schematic explaining the current survey study in the context of the broader aims of the SAGES-EAES Sustainability in Surgical Practice (SSP) task force

Fig. 2

Number of respondents by A U.S. State and B European country. Darker shades indicate more respondents

Fig. 3

General attitudes and education levels about sustainability. The proportion of respondents who chose the top two Likert options is highlighted

Fig. 4

Concerns about the negative impacts of improving sustainability. The proportion of respondents who were “not at all” or “slightly” concerned is highlighted

Fig. 5

Willingness to make specific sustainable changes. The proportion of respondents who were “quite willing,” “extremely willing,” or “already doing” the proposed change is highlighted

Fig. 6

Ranked choice preferences of sustainability education topics and modalities. We used a Borda count methodology. For example, if there were five options, respondents received five points for their first choice, four points for their second choice, three points for their third choice, two points for their second choice, and one point for their fifth (last choice). We added point tallies for each option