Greening the operating theatre: New review highlights strategies for sustainable perioperative care

An exhaustive review published in the British Journal of Anesthesia describes the practical approaches to reduce the environmental impact of anesthesia and surgery throughout the perioperative trip, with care of the patient and planetary.

Perioperative services are among the most intensive medical care activities, which contribute significantly to the substantial environmental footprint of Healthcare. A new narrative review published in the British Journal of Anesthesia provides a road map to reduce pollution and waste throughout the surgical care, from preoperative evaluation to postoperative recovery.

The review, written by experts from the University of British Columbia, the National University of Singapore and the Yale School of Medicine, emphasizes that medical care providers have both responsibility and the opportunity to mitigate the environmental impact of health while improving the quality of care.

The Paradox of Pollution of Medical Care
Medical care is responsible for 4.6% of global greenhouse gases emissions and a similar proportion of air pollutants, creating what the authors describe as a paradox: an industrialist dedicated to the healing that is simultaneously broken down into envisals. Perioperative services are particularly intensive in resources, since operational theaters are among the hospital areas most demanded by energy.

Although this challenge recognizes, the review offers hope: “There are opportunities to mitigate pollution through the entire continuum of perioperative care,” the authors write “, including those who occur typricing the patient’s operational room and the patient and the patient of the patient and the process of the process and the process and the process of the patient and the patient and the patient and the patient and the patient and the patient in the patient and the patient. postoperative

Surgical disease prevention
The authors emphasize that the most effective environmental strategy is to prevent the need for surgery completely. They highlight the role that medical care providers can play both in primary prevention and in defense of systemic changes that address the root causes of surgical conditions.

“Many surgical conditions are avoidable through primary or secondary prevention strategies or good management of chronic diseases,” establishes the review. The examples include health professionals who advocate for the legislation and policies that minimize surgical diseases, such as the laws of the safety belt, weapons control measures, the cycling infrastructure and the detection of intimate pair violence.

Appropriate care and shared decision making
The review emphasizes that high quality surgical decision making covers the selection of the correct operation, for the appropriate patient, by the correct supplier, in the right place. This approach not only improves the results, but also reduces the unnecessary use of resources.

Shared decision making stands out as particularly important. When patients are completely informed and participate in decisions about their care, studies show that approximately 20% of elective procedures would not be desired in optimized decision -making circumstances. The authors point out that decisions support tools not only help avoid unwanted procedures and associated contamination, but also increase knowledge scores, lead to more realistic perceptions of the benefits and damage of surgical treatment, reduce the decisive conflict, reduce uncertainty and generate a greater agreement between patient values ​​and decisional results. “

Anesthesia options conscious of the environment
The review provides a detailed guide to reduce the environmental impact of anesthetic practices, noting that hay anesthetics gases are powerful greenhouse gases with global warming potentials that vary from 144 to 2540 times than carbon dioxide.

It is identified that deflorano and nitrous oxide have climatic climatic impacts “one or two orders of magnitude greater than that of isoflurano and sevoflurane in relevant clinical doses, which suggests that the safe is avoided.” Some health systems have already eliminated the deflorano of the pharmacy formers given their huge environmental footprint and the availability of alternatives.

The authors also advocate low flow anesthesia techniques, which can significantly reduce anesthetic gas waste, and suggest prioritization of intravenous and regional anesthesia approaches when appropriate clinically. They point out that integral environmental impact evaluations show that inhaled anesthesia emissions are significant that those associated with intravenous and local anesthesia.

Circular economy principles for perioperative supplies
Medical devices, particularly consumables of a single use, represented another significant source of perioperative emissions. The review of applying circular economy principles to address this problem, including reduction, reuse, repair, reprocessing and recycling.

“The set of strategies to maximize the value of material resources in a circular economy is organized in a hierarchy, the reduction being the sustainability strategy of the capo,” explain the authors. They relieve the opening of the opening immediately required immediately duration and maintaining the “only” unopened but accessible materials.

The review cites evidence that reusable products are generally environmentally preferable to disposables. A systematic review of the perioperative evaluations of the product life cycle discovered that reusable products were environmentally preferable in 28 studies enclosed in rigid rigid light, laparotomy pads, respiratory tract of the laryngeal mask.

The authors also advocate modular and repairable medical devices and observe the potential of hybrid instruments that combine reusable handles with disposable components, which can reduce emissions with approximately equivalent.

Operating Theater Installations Emissions
The review addresses environmental impacts at the installation level, pointing out that the majority (90-99%) or the energy consumption of the operational theater is related to heating, ventilation and air conditioning. The authors suggest that, although individual doctors can have a limited influence on the energy consumption of the day until the day, the equipment can advocate for design modifications, renewable energy sources and greater efficiency at the institutional level.

They also highlight the problem of nitrous oxide leak through central pipe systems. Hospitals studies on three continents discovered that “the vast majority of nitrous oxide (75-95%) is filtered through the central pipes at the point of the multiple tank connections before use, and through the disarring of the dyscharge of the returns.” “” “” “Authors recommend the capture outputs of existing pipe systems and avoid new facilities.

Postoperative strategies for reduced environmental impact
After surgery, there are opportunities to mitigate environmental impacts by changing attention to less intensive environments, adopting a hospital care management approach and strengthening throughout the health system.

The authors indicate the tendency towards discharge the same day for procedures that previously require stages for hospitalized patients, including laparoscopic appendage, robotic prostatectomies, mastectomies with reconstruction and articular arthroplasty. They emphasize the role of improved recovery after surgery programs (ERAS) to facilitate early disassembly and the potential of hospital services of household any Anyaw “.” “” “” “” “” “” “” “” “” “” “” “

The review also addresses opportunities to reduce the unnecessary waste of medical supplies in postoperative rooms and in the ICU, and to minimize unnecessary laboratory research and diagnostic images. A study of hospitalized patients with General Acute Care Surgery revealed that 76% underwent unnecessary blood tests that last their stay at the hospital.

Mobile applications and virtual care platforms can also reduce the environmental impact of postoperative monitoring by decreasing visits in person, presentations of the emergency department and re -enters, the authors point out.

A holistic approach to sustainable perioperative care
The review concludes by emphasizing the need for a holistic approach that considers all the continuum of attention instead of focusing exclusively on operational theater practices.
“Surgical and anesthesia teams are positioned to modify considerable strips of medical care emissions,” write the authors.

“Within this holistic approach, doctors can participate in the prevention of surgical disease, guarantee the clinical decisions of the appropriate and be administrators of medical care resources. Innovation and collaboration are required logistes, and roads, and roads, roads and roads, and roads, and roads, and roads and roads and roads and paths and paths Patheways and Patheways and Patheways and Patheways and Patheways and Patheways and Patheways and Patheways and Patheways and Patheways PatheS’s Fathestical, Pathways Patheways Patheways.

Perhaps the most important thing is that the authors emphasize that environmental improvements also improve the quality of care: “The results will extend beyond the reduction of public health damages from the contamination of medical care to the provision of greater value and high value”

This integral review provides a practical framework for perioperative equipment that seek to reduce their environmental footprint while improving the results of patients, which shows that sustainability and clinical excellence can be synergy instead of competitive priorities.

Reference:
Macneill, AJ, Rizan, C. and Sherman, JD (2024). Improvement of sustainability and mitigates the environmental impact of anesthesia and surgery throughout the perioperative trip: a narrative review. British Journal of Anesthesia, 133 (6), 1397-1409.
DOI: https://doi.org/10.1016/j.bja.2024.05.042