7th March 2024
Surgery is one of the biggest areas of carbon emissions in health care. The Green Surgery report, produced by the UK Health Alliance on Climate Change, Brighton and Sussex Medical School, and the Centre for Sustainable Healthcare, is a practical evidence-based guide to reducing surgery’s environmental impact. The project was funded by the Health Foundation.
As a GP trainee and clinical fellow to the NHS Chief Sustainability Officer, I have some knowledge of the devastating health impacts of climate change, and the significant shifts needed for health care services to reduce their carbon emissions. But it’s useful to see the challenges laid out so clearly in the report. This is a valuable roadmap for anyone involved in surgical care, with many practical recommendations to improve and decarbonise surgery that are also applicable to other aspects of health care. Here are my takeaways:
1. Surgery is a health care carbon hotspot
Surgery is energy-intensive, with operating theatres using three to six times more energy than other parts of the hospital. Alongside the importance of using renewable sources of energy, avoiding unnecessary energy use will save both money and emissions.
I was shocked by the statistic that an estimated 90–99% of theatre energy consumption relates to heating, ventilation, and air conditioning (HVAC) systems. One case study showed that switching HVAC off at night when theatres were not in use saved 15–36 tonnes of carbon dioxide equivalent (CO2e) and £30,000 per theatre per year. If rolled out across the NHS, this could save £90 million and 108,000 CO2e annually.
It’s also remarkable that two-thirds of the carbon emissions of some operations are due to single-use surgical products such as operating instruments, gowns, and drapes. Case studies demonstrate that switching to reusable surgical items can save money, reduce carbon, and protect the supply chain from global shocks.
2. Decarbonising surgical care starts long before the operating theatre
As a GP I was pleased to see the report emphasise the importance of upstream prevention, as the best way to reduce carbon emissions from surgery is to avoid the need for an operation altogether.
Many leading causes of ill health like cardiovascular disease and cancer have modifiable risk factors, as do some of the most common reasons for surgery such as joint replacement and gallstones. Addressing risk factors such as physical inactivity and poor diet at a population level can have health and environmental co-benefits, which the Health Foundation has highlighted previously.
Even when surgery is one treatment option, it’s not always the best option for an individual. Trials of shared decision-making have shown an average of 1 in 5 elective procedures was not wanted by the patient. One approach to address this is the ‘Choosing Wisely’ movement, which promotes shared decision-making to ensure the right care for individuals based on their priorities, which really resonates with my values of person-centred and collaborative care.
3. Action to support greener surgical care can bring win-wins for patients, health systems and the planet
Many of the approaches described in the report aim to improve the ‘triple bottom line’ through benefits for patients, financial savings for the health system, and reduced environmental impact: win-win-win! For example, a case study showed that starting physiotherapy earlier after heart surgery reduced the length of time patients needed to receive intensive care, and saved over £1m and 48 tonnes of CO2e over 2 years.
The report also mentions NHS England’s Getting it Right First Time programme, a data-driven approach which works with providers to explore unwarranted variation in practice. A tool developed using these insights to optimise day surgery rates contributed to a 20% shorter orthopaedic stay and a 25% reduction in revision joint replacement surgeries.
4. Gaps must be addressed in research, innovation and implementation
The authors describe priorities for future research, including questions around sustainable and effective methods of infection prevention and control, and the need for consensus on how studies measure environmental impact. They also highlight the need for research on how to spread and scale existing sustainable surgery innovations such as those in the report’s case studies. Building on existing initiatives to spread good practice, such as the Intercollegiate Green Theatre Checklist and the Centre for Sustainable Healthcare’s Surgical Care Sustainability Network, there is clearly more to do on scaling innovations to maximise their impact.
5. NHS staff want to be part of the solution
I attended the launch of the report in November to a packed hall at a surgical conference. Many of the audience, from consultants to medical students, were keen to discuss how they could help take forward its recommendations. The positive reception made me reflect on the fact that most health care staff support NHS net zero targets, but may not feel equipped to help. For example, one survey of surgeons found they would welcome greater support, guidance, and leadership on sustainability.
This report provides a lot of guidance, but continuing to build capability among leaders and staff will be key in making its recommendations a reality.
Read and act
The Green Surgery report lays out a path to decarbonise surgery while optimising quality and efficiency of care. The aim is for us all not just to read it, but to act on its recommendations, many of which are relevant to all aspects of health care.
It prompted me to reflect on how I can influence sustainable care. I encourage others to take a look and see what interactions with your work you find.
This was first published on the Health Foundation website: https://www.health.org.uk/news-and-comment/blogs/five-takeaways-from-the-green-surgery-report
It originally featured in the Health Foundation email newsletter, which explores perspectives and expert opinion on a different health or health care topic each month.