Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
Adewale Adisa, Michael Bahrami‐Hessari, Aneel Bhangu, Christina George, Dhruv Ghosh, James Glasbey, Parvez Haque, JC Allen Ingabire, Sivesh K. Kamarajah, Laura Kudrna, Virginia Ledda, Elizabeth Li, Robert Lillywhite, Rohin Mittal, Dmitri Nepogodiev, Faustin Ntirenganya, Maria Picciochi, Joana Filipa Ferreira Simões, Lorna Booth, Robin Elliot, A S Kennerton, K L Pettigrove, L Pinney, H Richard, R Tottman, P Wheatstone, John W D Wolfenden, Annabel L. Smith, Ahmed E Sayed, Aakansha Giri Goswami, Aamer Malik, Aaron Lawson McLean, Abbas M. Hassan, Abd Jabar Nazimi, Abdallah Aladna, Abdalrahman Abdelgawad, Abdel Saed, Abdelfatah Abdelmageed, Abdelilah Ghannam, Abdelrahman Mahmoud, Abdul Rehman Alvi, Abdulaziz Ismail, Abdulhafiz Adesunkanmi, Abdulla Ebrahim, Abdullah Al‐Mallah, Abdullah K. Alqallaf, Abdullah Khan Durrani, Abdullah Gabr, Abdullahi Musa Kirfi, Abdulmalik Altaf, Abdulmjeed Almutairi, Abdulrahman J. Sabbagh, Abdulrazak Ajiya, Abdurrahman Haddud, Abed Alfattah Mahmoud Alnsour, Abhinav Singh, Abhishek Mittal, Abigail Semple, Abiodun S. Adeniran, Abraham Negussie, Abraham Oladimeji, Abubakar Bala Muhammad, Abubaker M Yassin, Abuzer Güngör, Achille Tarsitano, Adaiah Soibi‐Harry, Adam R. Dyas, Adam Frankel, Adam Peckham-Cooper, Adam Truss, Adamu Issaka, Adel Mohamed Ads, Adeleke Akeem Aderogba, Ademola Adeyeye, Adesoji Ademuyiwa, Adham Sleem, Adrian Papa, Adriana Cordova, Adu Appiah-Kubi, Adullah Meead, Aeris Jane D. Nacion, Afieharo Michael, Agustin Albani Forneris, Agustín Duro, Agustín Rodríguez González, Ahmad Altouny, Ahmad Ghazal, Ahmad Khalifa, Ahmad Ozair, Ahmad A Quzli, Ahmad Haddad, Ahmad Faidzal Othman, Ahmad Shuib Yahaya, Ahmed Elsherbiny, Ahmed Nazer, Ahmed Tarek, Ahmed Abu‐Zaid, Ahmed Al-Nusairi, Ahmed Azab, Ahmed Elagili
Abstract
BACKGROUND: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. METHODS: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries. RESULTS: In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. CONCLUSION: This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries.