0161 491 2534 (7:00am-22:00hrs) SECRETARY@VIVIENLEES.CO.UK

The carbon footprint problem
Surgery creates a considerable carbon footprint and as surgeons we need to think about ways that we can reduce this. In the UK 4% of the country’s carbon footprint is down to the NHS (not even allowing for activity in the private sector). Out of this about 30% of the footprint of the hospital is attributable to surgery including anaesthetic activity. I am conscious that over time the increasing use of disposable items, processing of items that are never actually used in the procedure and incorrect management of bag waste are all contributing to high levels of consumption and wastage as well as increasing carbon footprint.

What we can do to make things better

In theatre
The ways in which we can tackle the problem include developing the ‘lean and green’ theatre model where disposables are replaced as far as possible with recyclable items sourced in the UK and bag waste is reduced. Specific approaches include using surgical instrument trays with only the type of instruments that are needed for the particular operation. The size of the sterile surgical field can be reduced using less drapes. Discarded items are placed in the correct waste bags so that noncontaminated waste does not end up having to be incinerated (which puts carbon dioxide into the atmosphere). These maneuvers also reduce the length of time in theatre which itself means that the electricity, heating and anaesthetic gases used for the individual case are all reduced. Use of a minor procedures theatre, where appropriate and safe for the particular operation, is better than taking smaller cases through main theatres.

Changes to patient pathway
Making changes to the patient pathway can also reduce carbon footprint. What is meant by this is reducing the amount of time patients spend in hospital and with it the amount of staff resource that is committed in looking after each patient. A patient coming into hospital creates a carbon footprint because of needing electricity, heating and cleaning of the areas that you as the patient have occupied. If we can reduce the number of areas that you wait in during your admission then we improve efficiency, and carbon footprint. We also make the episode cheaper. I also offer to do some of the follow on outpatient visits by video link or telephone where appropriate to avoid having to get into your car.

‘Going green’ with carpal tunnel release surgery
With my colleague and MSc student Mr Preetham Kodmurai an assessment of the carbon footprint of carpal tunnel release surgery was undertaken along these lines. By making modifications it was possible to reduce the carbon footprint of the operation by 80%. Furthermore, bag waste which only contaminates the environment was reduced by two thirds. Taken together the combined costs of the consumables and sterilisation of hand instruments trays were reduced by two thirds representing a significant saving.

This picture shows the bag waste reduced from 3.1 to 1.4Kg using the ‘lean and green’ approach to consumables.