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Comparative Study
. 2025 Jan;27(1):e17247.
doi: 10.1111/codi.17247. Epub 2024 Nov 20.

Environmental impact of the enhanced recovery pathway in colorectal surgery: A simulation study

Karem Slim  1   2 , Julie Veziant  3 , Audrey Enguix  4 , Laurent Zieleskiewicz  5
Affiliations
Comparative Study

Environmental impact of the enhanced recovery pathway in colorectal surgery: A simulation study

Karem Slim et al. Colorectal Dis. 2025 Jan.

Abstract

Aim: Most of the literature on the environmental impact of surgery has analysed operating theatre practice in terms of its contribution to global warming (by greenhouse gas effects). The aim of this study was to assess the overall environmental impact of a complete perioperative pathway with and without implementation of an enhanced recovery programme (ERP).

Method: We compared two scenarios: an ERP scenario and a conventional scenario (CONV) for colorectal surgery. We carried out a lifecycle analysis for perioperative procedures, devices and consumables. We measured the impact on 17 environmental variables in addition to global warming.

Results: The overall environmental impact of ERP was 6% lower than that of conventional care. The reduction of impact due to ERP ranged from 5% for greenhouse gas emissions (18 kg CO2 equivalent less per intervention) to 27% for water consumption (3 m3 less). The stages that had the most impact on the environment were the preoperative stage (essentially owing to patient travel) and the intraoperative stage with the surgical part (medical devices representing 83.3% of the impact of the procedure) and the anaesthesia part (halogenated gases and ventilation representing 54.9% of the impact of anaesthesia care).

Conclusion: This study found an ERP approach to be more eco-responsible than conventional care. This is an additional benefit of ERP implementation. The impact of ERP implementation might be further reduced by action on the preoperative and intraoperative stages.

Keywords: colorectal; enhanced recovery after surgery; environment; greenhouse gas; surgery; sustainability.

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Conflict of interest statement

KS declares a conflict of interest with Sanofi and Lillial, with no relationship with the present work.

Figures

FIGURE 1
FIGURE 1
Overall and relative environmental impacts of conventional (CONV; blue) and an enhanced recovery programme (ERP; orange) scenarios.
FIGURE 2
FIGURE 2
Relative environmental impacts of the surgical procedure (colectomy by laparoscopy) in conventional (CONV; blue) and an enhanced recovery programme (ERP; orange) scenarios.
FIGURE 3
FIGURE 3
Relative shares of processes and medical devices in the environmental impact of the surgical procedure (laparoscopic colectomy) in the ERP scenario. Only items representing more than 6% of total impact were included.
FIGURE 4
FIGURE 4
Relative environmental impacts of anaesthesia in conventional (CONV; blue) and an enhanced recovery programme (ERP; orange) scenarios.
FIGURE 5
FIGURE 5
Relative shares of processes and medical devices in environmental impact of anaesthesia in the enhanced recovery programme (ERP) scenario. Only items representing more than 5% of total impact were included.
FIGURE 6
FIGURE 6
Relative shares of the three perioperative stages in the environmental impact of the enhanced recovery programme (ERP) scenario (orange, preoperative; green, intraoperative; blue, postoperative).
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