Landmark report on reducing environmental impact of surgical care published

28th November 2023

Reducing the environmental impact of surgical care while maintaining high-quality patient care is the subject of a new landmark report produced by the UK Health Alliance on Climate Change (UKHACC), Brighton and Sussex Medical School (BSMS) and the Centre for Sustainable Healthcare.

In what is thought to be the first detailed account of its kind, the ‘Green Surgery’ report includes a clear set of recommendations on achieving net zero surgical care.

Reducing and reusing products used in surgery, shutdown checklists for operating rooms to save energy when not in use and switching to less harmful anaesthetics are all highlighted as ways in which carbon emissions could be reduced.

The report also highlights the importance of surgeons and patients working together to optimise their treatment, as well as the role of disease prevention and health promotion in transitioning to more sustainable models of surgical care.

Commenting on the scope of the report, Dr Richard Smith, chair of the UKHACC, said: ‘This report assembles all the current evidence and is filled with recommendations, some of them easy to implement, others more difficult.

‘Although the report has been produced primarily with the UK in mind, there is much that will be useful to surgical teams everywhere. Nobody knows how to achieve net zero in surgical practice, and the report makes clear that much more research and innovation will be needed.

‘We need urgently to improve funding for getting all of healthcare, including surgical practice, to net zero, and we need to provide training and career paths for researchers.’

Involving significant input and collaboration with individuals and organisations working across the surgical care pathway, the report is aimed at everyone involved in surgical care, including colleges, associations and societies, the NHS, suppliers, policy makers, clinicians and patients.

In the UK, surgical care is responsible for an estimated 5.7 million tonnes of carbon dioxide emissions each year, according to the report, which is equivalent to that from heat, electricity, transport and waste of 700,000 UK homes.

Professor Mahmood Bhutta, consultant ear, nose and throat surgeon, professor of sustainable healthcare at BSMS, and chair of the committee leading the project, said: ‘We know that staff in the NHS, including surgical teams, are keen to reduce the environmental impact of the care they provide.

‘We hope this report will provide them with a roadmap and tool to support them on that journey. Providing surgical care and protecting the planet can, and should, go hand in hand.’

Dr Chantelle Rizan, clinical lecturer at BSMS and academic chair and a leading author on the report, added: ‘We are developing a growing body of research that provides an evidence-based strategy for how we can reduce the environmental impact of surgical care.

‘Now it is time to translate that research into real-world action, and to drive the transition to sustainable models of high-quality patient care. We must build on win-wins where there are co-benefits for patients, the environment and the public purse.’

She added: ‘What we do between now and 2030 is of utmost importance and we cannot wait for systems to change. We need to all be taking action tomorrow and thinking about that one thing that we can commit to.’

Earlier in November, the World Health Organization published a new operational framework for building climate-resilient, low-carbon and sustainable health systems across the world.

And last month, the International Hospital Federation’s Geneva Sustainability Centre launched a new platform to digitally empower hospitals and healthcare leaders​ to drive sustainable, low-carbon, equitable and resilient healthcare.

Surgeons lose one working month a year due to outdated technology, study finds

26th July 2023

Surgeons in the UK lose an average of four working hours a week – equal to one working month a year – due to inefficient technology, according to a new survey by Censuswide on behalf of Medtronic.

The ‘State of Surgery in the UK’ survey explored surgeons’ attitudes towards the technologies they use in their role, the efficiency of them and the degree to which they enhance or hinder performance.

Some 79% of the 300 respondents said surgical care would be easier to deliver if technology was improved, and 58% agreed that technology in the operating room is inefficient and could impact the delivery of patient care.

In addition, 54% of surgeons reported spending time outside of hospital hours on administration that could be automated, and 56% of surgeons agreed time spent on administrative and logistical tasks could be reduced with better technology, which could free them up to focus on upskilling themselves and their team in other areas.

Commenting on the findings, Professor Sanjay Purkayastha, consultant upper GI and bariatric surgeon at Imperial College, NHS Healthcare Trust, and honorary professor at Brunel University, said: ‘The survey results reflect a challenge that many of us in the surgical community know all too well. For many surgeons, the lack of adequate technological support throughout the patient pathway leaves the surgical team perpetually short on time. Time that could be used on crucial analysis and training. An upgrade in the technologies available to surgeons is long overdue.

‘The enhanced efficiency and accuracy we gain from a more integrated and intelligent operating room are undeniable. In surgery, the benefits of being proactive, rather than reactive, are critical to maintaining a high quality of care. Digital technologies will be key to sustaining this. Unfortunately, these benefits remain out of reach for far too many in our field.’

Professor Naeem Soomro, consultant urological surgeon at Newcastle’s Freeman Hospital and Royal College of Surgeons Council member, added: ‘These findings validate and mirror our own research highlighting that the future of surgery lies in more forward-facing digital solutions. Robotics, data and artificial intelligence will allow the NHS to respond to current challenges around access, safety and sustainability of healthcare.’

The future of robotic assisted surgery

This comes as the Royal College of Surgeons of England published a new guide covering some of the challenges – such as accessibility, variable outcomes and possible patient harm – and benefits of robotic surgery, including greater precision, freeing up hospital beds and improving patient recovery.

The guide, ‘Robotic assisted surgery: A pathway to the future’, also looks at the potential future application of robotics and makes recommendations to encourage sound governance practices that can lead to the safe adoption and expansion of robotic surgery in UK hospitals.

It proposes a structured pathway for established surgeons who want to transition to robotic-assisted surgery and identifies the relevant roles and responsibilities of key stakeholders for ensuring and maintaining safe autonomous practice in robotic surgery.

Nuha Yassin, consultant colorectal surgeon, robotics and minimally invasive surgery and RCS England Council lead for the future of surgery, robotics and digital surgery, said: ‘This timely new guidance will support the safe and structured introduction of robotic assisted surgery – and the fruitful collaboration between hospitals, surgeons and industry. It’s important for the surgical profession, led by RCS England, in collaboration with the surgical speciality associations, to take charge of all processes, accredit training centres and pathways and facilitate equity in access and training.

‘To benefit from the potential advantages, any investment in purchasing robots needs to be accompanied by proper planning for its introduction into the service with a focus on training, quality assurance and efficiency. This also needs to acknowledge the variable learning curve which can be long for some surgeons and theatre teams before these efficiencies can be observed at a large scale.’