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Forging a Sustainability Culture in Surgery


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The paradox

Did you know that the NHS emits more carbon dioxide (CO2) annually than all the passenger planes taking off from Heathrow each year? As healthcare professionals help combat the health consequences of climate change, they paradoxically contribute to the threat. The NHS is one of the top producers of greenhouse gases in the United Kingdom, emitting more carbon than the global average for healthcare. Within the NHS, surgery has a major environmental impact. If the carbon footprint of surgery is not reduced, the NHS will fall short of its net zero target.


Surgery is scary, but it gets worse

A single hour-long operation generates around 24 kg of CO2, the equivalent of driving to Brighton with an average petrol car. This accounts for energy, consumables, equipment, and staff travel, but not anaesthesia yet 2% of the NHS’ carbon footprint is attributable to anaesthesia. In 2017, the total volume of anaesthetic gases used during surgical procedures in the NHS produced 200 kt CO2e. To put this in context, a flight from London to New York and back emits 986 kg of CO2 per person. To emit 200 kt of CO2, it would take 202,839 round-trips from London to New York. Anaesthetic gases are deleterious to the environment, with desflurane and nitrous oxide among the most damaging. When the carbon impact of surgery is combined with anaesthetic gases and the ever-increasing backlog, it becomes obvious that the carbon footprint of surgical care pathways is dangerously escalating. As this frightening truth is brought to light, solutions to provide environmentally friendly surgery begin to emerge.


The resurgence

The world’s first net-zero operation was performed by the NHS. Doctors at Solihull Hospital in the West Midlands performed a five-hour carbon-neutral bowel cancer surgery. The hospital collaborated with experts from the University of Birmingham to carry out the green operation with evidence-based approaches. They changed their standard practice by using reusable items, providing intravenous anaesthesia rather than anaesthetic gases, implementing a plan to reduce electric use, recycling waste, and cycling or walking to work. They reduced the carbon impact of the surgical workflow by 80%. A major victory pointing to the door that leads to net-zero surgery, but what played the pivotal role?


The key to sustainability’s door

Education is key as it can change behaviour. Take food labels as an example. When diet-related public health issues arose, food labels were introduced on packaging. It increased public awareness and education, which changed consumer dietary intake and encouraged people to make healthier choices.


Healthcare professionals want to be sustainable, but it can be challenging to think about the carbon impact of their decisions when patient safety is at the forefront of their mind. Many individuals are unaware of the extent to which their individual actions can affect the environment. Without knowledge of which alternatives are more eco-friendly, they cannot make more eco-conscious decisions. This is why a sustainable culture within healthcare is vital. Awareness needs to be embedded within surgical care pathways so care providers can make informed decisions while considering the environment. Without a robust implementation plan that trains and supports surgical teams to place interventions, change cannot happen.


At Open Medical, we strive to empower healthcare systems to reduce the carbon footprint of surgery by implementing sustainable functionalities into our user-friendly platform PathpointⓇSurgiCare. SurgiCare is a cloud-based interface that transforms the model of care by streamlining clinical workflows and regional care pathway coordination, achieving efficiency savings and enhancing patient care. Surgical inpatient stays are responsible for around 138 kt of carbon dioxide emissions while patient travel produces 26 kt of CO2 emission per year. When addressing the carbon footprint of surgery, factors beyond the operating room should be considered, and SurgiCare encompasses the entire patient journey. By streamlining clinical workflows and creating efficiency savings, SurgiCare can reduce postoperative length of inpatient stay and travel emissions. Additionally, SurgiCare will do more than enable carbon-neutral options, it will raise awareness. The implementation of sustainable features will inform caregivers about the carbon footprint of operating rooms, hospitals, and trusts as well as more granular estimations of the carbon impact from paper letters to surgical equipment and patient travel. The sustainable nudges immersed throughout the pathway will encourage both patients and clinicians to make more environmentally friendly choices. Extrapolating the elective backlog across 6 million patients can potentially save 571.5 kt of CO2 emissions.


We have recently been awarded £798,923 as part of a Small Business Research Initiative Phase 2 grant which will allow us to achieve our goal to measure, promote, and enable sustainable decisions in surgery. Education influences behaviour but it is only when behaviour changes that a new culture can emerge.




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