Sustainable Surgery: here’s what it’s all about

The goals set by the United Nations to achieve better levels of sustainable development across the planet by 2030 also involve the health sector, although this is not the main thought of patients and their families when facing treatment for an illness. An entirely understandable attitude that, however, does not exempt the medical-surgical field from doing some reflections.

Professor Antonino Spinelli    General Secretary of the European Society of Coloproctology (ESCP) and Head of the Colon and Rectum Surgery Unit at Humanitas Research Hospital, addressed this issue in an article entitled “Operation Sustainable Surgery: saving lives must not be to the detriment of the Planet“, published in August on the scientific website Medscape. According to Professor Spinelli, “the healthcare sector, and especially operating rooms, are very resource intensive.” For example, the British National Health Service, which has the ambition to become carbon neutral by 2040, currently produces 24.9 million tons of CO2 per year: a single surgical department produces about 5,000 tons of CO2 in twelve months, while every single surgery is responsible for the production of 173 kilograms of CO2.

The scientific journal The Lancet calculated that the healthcare sector is responsible for 4.6 per cent of global carbon emissions. “It is true,” Spinelli explains, “that surgeons have other duties and thoughts, but it is equally true that every surgeon must no longer focus only on the health of patients as an indicator of success, but also on safeguarding the environment, the world’s population and future generations. In this regard, our European Society of Coloproctology is leading a campaign to improve practices and to better understand the obstacles colorectal surgeons are facing.  However, to implement many of the changes that need to be made, the surgical society needs more collaboration on an organizational, national and international level.”

How can surgeons begin to make a difference in practice? By starting with the little things, like everyone else: opening up in the operating room only those instruments that will certainly be used, starting to take more advantage, where possible and safe, of telemedicine and other technologies. And focus more on prevention, in order to avoid unnecessary surgery.
“But a great effort must be made by hospital boards, medical device manufacturers, and health policy makers,” Spinelli clarifies. For example, on single-use products used during surgeries, a deep reflection can be made: “Although used with the intent to prevent surgical infections, their use is correlated with increased CO2 production.  It would be appropriate to establish an evidence-based list of safe and properly sterilized multiuse instruments to be used when possible. Nearly a decade ago, the Association of Surgeons of Great Britain and Ireland issued a consensus statement on cost-effective surgery in which the authors stated that the risk of cross-infection with single-use surgical instruments is “infinitely small,” but that “hysteria leads to colossal waste.” Since then, progress has been slow”.

Another crucial issue concerns the financial interests of medical device manufacturers: “The more we buy single-use products, the greater their profits will be. So we should question part of the industry’s insistence that some items must be single-use,” Spinelli continues, suggesting that “to instil greater change in the industry, hospital leadership must use its agency to procure reusable instruments and work with manufacturers to find new and innovative solutions.”

A third point is the consumption of water, always very high in operating rooms: some studies suggest, in this regard, that the safety for surgeon and patient remains unchanged whether you wash your hands in the traditional way or using alcoholic products that do not require washing with water. This would save 60.2 liters of water per procedure.

Finally, the gasses used for anaesthesia also play a central role because, as they are recognized as greenhouse gasses, they contribute to 5 percent of the CO2 emissions of the entire British National Health System. “We could, however, replace them with low-flow anaesthesia, or with ‘blue zone technologies’ that capture, recover and purify halogenated agents; or with total intravenous anaesthesia, which avoids their use altogether.”