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Blog: Reducing the carbon footprint of surgical care

15 Nov 2023

This week, a new report has been published by UK Health Alliance on Climate Change, Brighton and Sussex Medical School and the Centre for Sustainable Healthcare, which explores how to reduce the environmental impact of surgical care while maintaining high quality patient care and potentially saving the NHS money.

The release of the Green Surgery Report marks a ground-breaking step towards a more sustainable and environmentally conscious approach to healthcare.

In the below blog, Dr James Phillips, Consultant in Obstetrics & Gynaecology at Nottingham University Hospitals NHS Trust explores the huge potential impact of the report.  

It is believed to be the world’s first detailed account of how to reduce the environmental impact of the entire surgical pathway. It will help to provide individuals and organisations with the information and evidence to make sustainable improvements to surgical care that will often also improve patient care and reduce financial costs. The report includes recommendations relevant to policy makers through to clinicians and patients, as well as case studies giving examples of real world change.

The report has a surgical focus and the advice will be most relevant to gynaecological and obstetric surgery, but those across the field of O&G will see the relevance to their practice. I hope that it will prompt further work to produce similar guidance for pregnancy and birth.  

What many people may not know is that operating theatres are resource intensive – a typical operation has the same carbon footprint as driving a petrol car from London to Aberdeen. The biggest contributors are anaesthetic gases; energy usage (heating, ventilation and air-conditioning); and equipment, particularly single-use products.

Some changes we can make are simple – do you need to wear a pair of gloves to move a patient onto a theatre table? Is the theatre ventilation system turned off out of hours?

Some changes are already happening – increasing use of remote consultations (reducing patient travel) and outpatient procedures where possible (these require less staff and outpatient rooms have a lower carbon footprint than energy intensive theatres).

Sometimes practice may need to revert to what was done before – such as reusable gowns and drapes, and reusable specula (1/4 to 1/3 of the carbon footprint of single use). Is an advanced bipolar device required to surgically manage an ectopic pregnancy? My urogynaecology colleagues may regard vaginal hysterectomy as the ultimate minimal access operation – it also has a quarter of the environmental impact of a laparoscopic hysterectomy.

Some require a bit of thought, such as engaging with Getting it Right First Time initiatives to reduce unwanted variation and unnecessary procedures. Switching from single use to reusable surgical devices reduces the carbon footprint by 1/3 to ½, which will often be higher quality and save money too. Where single use sets are used, we can work with suppliers to remove equipment that is never used.

Some are more contentious, such as the environmental impact of pain relief choices in labour. Nitrous oxide (in Entonox) lasts for 114 years and has 270 times the global warming potential of CO2. Scavenging systems have become widespread to protect healthcare workers, but the waste gas is released into the atmosphere as cracking technology is expensive. Do pregnant women want to weigh up this alongside all the other factors they may consider when making their choices?

We’re all busy, budgets are tight and we have many competing pressures, but this matters. Hopefully you will feel empowered by the Green Surgery Report and look to find out more. There are actions we can all take, and some are quite straightforward. You could consider getting in touch with your Trust green plan team, as they are often struggling for clinician engagement.  The Centre for Sustainable Healthcare also provides resources, runs courses and facilitates networks for the sharing of knowledge.  

  • Clinical and research
  • Careers and workforce
  • Gynaecology