Green surgery

Environmental sustainability within surgery is gaining traction, and not before time. We have a responsibility to our children and those who follow us to be wise stewards and guardians for the future. How we act has a significant effect on the world today and into the future. Increasingly we understand that medicine, including surgery, has a marked impact on the environment.

On 19 November 2022, RACS became the first Australasian medical college to publicly support the Green College Guidelines (https://bit.ly/3izkamx ). The guidelines, produced by Doctors for the Environment Australia (DEA), detail practical steps medical colleges can take to reduce their carbon footprint.

Meanwhile, there is a growing interest in the medical profession itself as to how it can cut emissions and reduce waste without compromising the quality of care.

Enter the Intercollegiate Green Theatre Checklist (https://bit.ly/3gXytkf ).

Four UK and Ireland surgical colleges have developed this checklist and are encouraging surgeons and operating theatres to make them part of their daily practice as part of theatre briefings.

There are four sections: anaesthetic care, preparation for surgery, intraoperative and post-operative. Together they aim to affect the ‘triple bottom line’ of environmental, social, and economic considerations, and in this way are applying the principles of sustainable quality improvement in healthcare.

The colleges have also compiled a collection of peer-reviewed evidence, guidelines, and policies that have informed the creation of the checklist. Healthcare’s climate footprint is equivalent to 4.4 per cent of global net emissions (two gigatons of carbon dioxide equivalent)1. Put another way, the global healthcare climate footprint is equivalent to the annual greenhouse gas emissions of 514 coal-fired power plants. If the health sector were a country, it would be the fifth-largest emitter on the planet.

Surgery is one of the most resourceintensive areas of a hospital. It uses three to six times more energy than the rest of the hospital and creates a lot of waste. The carbon footprint of a single operation has been calculated as ranging from six to 814 kg carbon dioxide equivalents2 – between 22 and 2907 miles in an average petrol family car.

We encourage you to look at the resources and consider implementing the green checklist in your own operating theatres.

You can send your feedback to: Sustainability@rcsed.ac.uk

Authors: Dr Sarah Rennie and Professor Spencer Beasley, Aotearoa New Zealand Surgical Advisors (pictured below)

1 https://noharm-global.org/sites/default/files/ documentsfiles/5961/HealthCaresClimateFootprint_092319.pdf

2 Rizan C, Steinbach I, Nicholson R, Lillywhite R, Reed M, Bhutta MF. The Carbon Footprint of Surgical Operations: A Systematic Review. Ann Surg. 2020 Dec;272(6):986-995. doi: 10.1097/ SLA.0000000000003951. PMID: 32516230.