Image Credit - Medical Device Network
Green Surgery: The Future of Healthcare
Green Surgery: The Key to Sustainable Healthcare
The world faces an intensifying climate crisis, making the reduction of carbon dioxide emissions an urgent global priority. Surprisingly, the healthcare sector plays a significant role in this crisis. In fact, if the global healthcare sector were a country, it would rank as the fifth-largest carbon emitter. Within this context, the UK's National Health Service (NHS) alone generates about 6% of the nation's carbon footprint.
Operating theatres represent a particularly carbon-intensive aspect of healthcare, accounting for approximately 25% of hospital emissions. However, since a majority of us will require some form of surgical intervention in our lifetime, finding climate-conscious solutions is paramount. Fortunately, researchers and healthcare leaders are making significant strides in developing what is known as 'green surgery' with the aim of reducing healthcare's environmental impact.
Spearheading the Green Surgery Movement
The University of Birmingham's NIHR Global Health Research Unit on Global Surgery is at the forefront of this drive towards sustainable healthcare. Mr Aneel Bhangu, a Professor of Global Surgery and Lead Clinician Scientist in the NIHR Global Surgery Unit at the University of Birmingham, believes this offers a tremendous opportunity to reduce the healthcare sector's carbon footprint.
To explore and advance green surgery solutions, surgeons and researchers from across the globe convened at the University of Birmingham in late 2023 for the groundbreaking Research for Greener Surgery Conference. This event aimed to find ways to decarbonise surgery while upholding the highest patient care standards.
Image Credit - University of Birmingham
Groundbreaking Net-Zero Surgery
The conference built upon earlier pioneering work, such as the NHS's first fully documented net-zero operation, successfully performed at Solihull Hospital in 2022. This landmark procedure involved the safe removal of bowel cancer using minimally invasive techniques.
To achieve this net-zero feat, University of Birmingham experts partnered with a surgical team at University Hospitals Birmingham NHS Foundation Trust. They carefully modified standard surgical practices by:
Opting for reusable gowns, drapes, and scrub caps
Reducing electricity usage wherever possible
Prioritising intravenous medications over anaesthetic gases, which have potent greenhouse effects.
In preparation, the team utilised evidence-based guidelines and a specially developed carbon output calculator – now part of the Green Surgery toolkit designed to promote carbon-reduction measures.
Challenges and Opportunities
The success of this net-zero surgery provided a crucial foundation for further innovation. The December conference was launched by Professor Lucy Chappell, Chief Executive Officer of the National Institute for Health and Care Research and Chief Scientific Advisor for the Department of Health and Social Care. She underscored the necessity of an evidence-based approach to net-zero surgery and acknowledged the challenges involved.
Professor Chappell highlighted the critical role of research in tackling the climate challenge and the importance building partnerships across the UK to maximise impact. The work of the NIHR Global Surgery Unit exemplifies this collaborative approach, receiving a dedicated NIHR Green Surgery grant to support the development and implementation of NHS interventions.
The Wider Implications of Climate-Conscious Healthcare
Recognising that climate change and human health are inextricably linked, the conference emphasized how research initiatives can shape a greener, more patient-centered healthcare model. Additionally, it explored the role of research in promoting change both within the healthcare system and at the societal level.
In a significant step, the NHS has set an ambitious goal of achieving net-zero emissions by 2040. But without concerted efforts to make surgery more environmentally sustainable, this target will remain out of reach. Changes in behavior, care pathways, and resource use within operating theatres are essential.
Defining Sustainable Surgery
So, what exactly does sustainable surgery entail? Broadly, it can be characterized across the following three interlinked themes:
Capacity: Ensuring there is a sufficient workforce, along with the necessary infrastructure, to increase the volume of surgical care provided safely.
Training: Harnessing digital innovations to upskill future healthcare professionals, empowering them to make informed choices that prioritize both patient care and environmental impact.
Environmental Sustainability: The critical focus area for transforming highly resource-intensive practices within the surgical setting.
A Vision for the Future
Creating dedicated elective surgery centers could enhance surgical capacity. Likewise, changing habits within operating theatres can reduce waste. However, a broader transformation is needed. This could involve a combined health and education strategy focused on solar energy adoption to decarbonize the healthcare system and simultaneously promote environmental awareness in schools and communities served by local medical practices.
Ultimately, a multifaceted approach is needed to tackle the climate crisis. Sustainable surgery practices offer a way to significantly decrease healthcare's carbon emissions while safeguarding quality patient care. The UK's NHS and research pioneers are charting new territory and setting an example for the rest of the world to follow.
Transforming Operating Theatres
Operating theatres are the beating hearts of hospitals, where complex, life-saving procedures take place. However, they are also hotspots of energy consumption, waste generation, and substantial carbon emissions. So, how can these highly specialized spaces be reimagined to reduce their environmental impact?
One key factor is the use of anaesthetic gases. Desflurane, a commonly used anaesthetic, is a particularly potent greenhouse gas, having a global warming potential far exceeding that of carbon dioxide. Fortunately, there are alternatives with vastly lower environmental impact, along with intravenous (IV) anaesthetic options. Opting for these alternatives, whenever safe and suitable, provides a significant carbon-saving opportunity.
Alongside medication choice, there's the often-overlooked matter of unused supplies. Opening sterile instrument packs or medications that ultimately go unused generates significant waste and avoidable emissions associated with production and disposal. Careful planning and optimized surgical workflows can play a role in reducing surplus materials.
Changing established practices doesn't happen overnight, but small shifts can add up. Simple yet impactful changes can include minimizing electricity use by turning off unnecessary equipment and lights, as well as carefully planning surgical schedules to avoid delays that lead to further energy consumption.
Rethinking Disposables
The healthcare industry has become heavily reliant on single-use, disposable items. While designed with hygiene in mind, this contributes to a massive waste problem and, subsequently, greenhouse gas emissions. Wherever possible, switching to reusable alternatives like gowns, drapes, and surgical instruments can make a real difference. Of course, this requires robust sterilization processes to ensure patient safety is never compromised.
Beyond the operating theatre, addressing procurement and supply chains is essential. Working with environmentally responsible suppliers and making careful choices about the products purchased can have a far-reaching impact in reducing upstream carbon emissions.
Measuring Success
Quantifying the true environmental cost of a surgical procedure isn't always straightforward. Fortunately, tools like the Green Surgery Calculator developed through the NIHR collaboration are helping to change that. Armed with reliable data, surgeons and healthcare administrators can make more informed decisions about resource utilization, supply choices, and waste management strategies.
Data also plays a vital role in driving research and innovation in green surgery. By systematically tracking the carbon footprint of different procedures and interventions, researchers can identify the areas with the highest potential for improvement. This evidence-based approach ensures that efforts are focused where they will have the greatest benefit.
The Role of Patient Engagement
While much of the focus is understandably concentrated on reducing the footprint of the surgical process itself, patient engagement cannot be overlooked. Informed patients can become partners in sustainability efforts. For example, where clinically appropriate, offering less carbon-intensive alternatives, such as local anaesthesia over general anaesthesia for certain procedures, can empower patients to make choices aligned with both their health goals and environmental values.
Challenges and Collaboration
The path towards truly sustainable surgery isn't without its challenges. Established routines, ingrained habits, and the perceived financial implications of change can create barriers. However, it’s essential to remember that environmentally responsible practices don't have to come at the expense of patient care or financial viability.
In fact, reducing waste and optimizing resource use can lead to cost savings over time. Furthermore, investment in energy-efficient technologies and sustainable procurement practices may have long-term economic benefits.
Change also requires overcoming skepticism that may exist within the surgical community. Building trust, engaging clinicians as stakeholders, and demonstrating that green practices enhance rather than hinder patient care are crucial. Success stories, evidence-based research findings, and clear communication will be instrumental in changing perceptions and fostering a culture of sustainability within surgery.
A Global Movement
The UK's commitment to net-zero healthcare serves as inspiration, but this is a challenge that extends far beyond national borders. The climate crisis demands a truly global response, and fostering international collaboration in the realm of green surgery is paramount.
Sharing best practices, developing standardized measurement tools, and pooling research efforts across countries and healthcare systems will accelerate progress. Low- and middle-income countries, often disproportionately affected by climate change, may face unique obstacles in developing sustainable surgery practices. International partnerships and knowledge-sharing initiatives become especially important in supporting progress in these regions.
Education as a Catalyst
The current generation of surgeons and healthcare professionals can lead the way in transforming surgical practice, but the next generation will be pivotal in embedding sustainability as a core principle of medicine. Medical education must evolve to include environmental awareness, equipping future healthcare leaders with the understanding and tools to make climate-conscious choices in their practice.
This calls for the integration of planetary health and sustainability concepts into curricula, as well as training in the practicalities of implementing green surgical protocols. Collaboration between medical schools, research institutions, and healthcare providers is needed to create a pipeline of professionals committed to environmentally responsible patient care.
Beyond Surgery
While the focus here has been the direct environmental impact of surgery, it's worth considering how the green surgery movement can spill over to broader healthcare practices. The principles of reducing waste, optimizing resource use, and re-evaluating established practices can be applied across a variety of healthcare settings.
Green surgery has the potential to serve as a catalyst for a system-wide shift towards more sustainable and resilient healthcare. From clinic appointments delivered virtually to responsibly managed pharmaceutical supply chains, there are countless opportunities to reduce the sector's environmental footprint.
A Vision for the Future
The journey towards net-zero healthcare is a long one, but the advancements in green surgery we're witnessing offer a beacon of hope. Through commitment, collaboration, and a willingness to reimagine established practices, the healthcare sector can play a pivotal role in mitigating the climate crisis while safeguarding the health of our planet and its people.
A Call to Action
The climate crisis demands urgent action across all sectors, and healthcare is no exception. The pioneering work in green surgery happening in the UK and beyond demonstrates that change is possible. However, transforming the way we deliver surgical care requires a concerted effort from all stakeholders within the healthcare community and the wider society.
Surgeons, anaesthetists, nurses, and hospital administrators must embrace a commitment to sustainability, integrating climate-conscious practices into their daily work. They must become champions of change, leading by example and engaging their colleagues in reducing waste, optimizing resource use, and advocating for system-wide transformation.
The Future of Surgery
Healthcare institutions have a vital role to play in supporting these efforts. Investing in energy-efficient technologies, implementing sustainable procurement policies, and providing training for staff in green surgery principles will lay the foundation for long-term success. Collaboration with universities and research centers can drive innovation and the development of evidence-based solutions.
Policymakers at the national and international level hold the power to create enabling environments that incentivize environmentally responsible healthcare. Legislation aimed at reducing carbon emissions, supporting resource efficiency, and promoting sustainable practices can significantly influence the trajectory of the healthcare sector.
Patients and the public also have a part to play. By raising awareness about the link between climate change and healthcare, demanding transparency and accountability from healthcare providers, and supporting initiatives aimed at creating a greener healthcare system, the public can be a powerful force for positive change.
The path to sustainable surgery may not always be easy, but it's a journey we must embark on for the sake of both our planet and future generations. By working together, embracing innovation, and upholding the highest standards of patient care, we can build a healthcare system that not only heals people but contributes to the healing of our planet.
Conclusion
The vision of green surgery offers a future where healthcare becomes a beacon of environmental responsibility. It's a future where operating theatres are transformed into hubs of sustainability, where waste is minimized, resources are used efficiently, and carbon emissions are drastically reduced. This transformation doesn't just benefit our environment, but it ripples outward to create a healthier, more resilient society.
Embracing sustainability within surgery isn't simply an ethical imperative – it's about future-proofing healthcare itself. As climate change intensifies, resource scarcity and supply chain disruptions may become increasingly challenging. A healthcare system proactively designed around sustainability will be far better equipped to navigate these uncertain times.
The work being done today to develop green surgical practices is laying the groundwork for a fundamental shift in the way healthcare is delivered. As research, innovation, and collaboration continue to drive progress, we can envision a future where surgery sets a shining example of human ingenuity in service of both planetary health and patient well-being.
