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Green Surgery Report Structure

The Green Surgery report will provide recommendations and guidance across the surgical care pathway



1.1 Interplay between human health and planetary health
1.2 Delivery of surgical care in the United Kingdom
1.3 The environmental impact of surgical care
1.4 Opinions of patients, public, and healthcare staff
1.5 Labour rights harms in surgical products
1.6 Principles of sustainable healthcare and use of the triple bottom line

Public health

2.1 Prevention of surgical disorders
2.2 Health promotion and optimising surgical patients
2.3 Minimising unwarranted variation and low value care

Surgical care pathways

3.1 Streamlining surgical patient care pathways (diagnostic + non-surgical management)
3.1.1 Reducing unnecessary steps
3.1.2 Remote and digital care
3.2 Pre-operative
3.2.1 Shared decision making
3.2.2 Patient optimisation and risk reduction
3.3 Operative
3.3.1 Impact of setting
3.3.2 Impact of timing of intervention
3.4 Post-operative
3.4.1 Impact of length of hospital stay
3.4.2 Optimising recovery and rehabilitation

Operating theatre design and energy

4.1 Theatre design and infrastructure
4.2 Energy use in the operating theatre


5.1 Local & regional anaesthesia
5.2 General anaesthesia surgery
5.3 Circular economy principles in anaesthesia delivery

Products used in surgical care

6.1 Principles of a circular economy for medical products
6.2 Opportunities to reduce and rationalise equipment
6.3 Reusable equipment
6.3.1 Sterilisation and laundering
6.3.2 Repair and longevity of medical products
6.4 Manufacture
6.5 Transport and distribution
6.6 Reprocessing of medical devices
6.7 Waste and recycling

Barriers and facilitators to implementation

7.1 Knowledge, attitudes, and behaviours
7.2 Education
7.3 Clinical leadership
7.4 Infection prevention control and decontamination
7.5 Medical supply chain
7.6 Supporting infrastructure

Areas for future research and development

8.1 James Lind Alliance sustainable perioperative practice priority setting partnership
8.2 Wider research and innovation


9.1 Clinical surgical teams
9.2 Clinical support services (e.g. Infection Prevention Control, Radiology, Pathology)
9.3 Executive and management teams in healthcare organisations
9.4 Other hospital departments
e.g. finance, estates, procurement, waste management, information technology
9.5 Supporting industries and supporting services (e.g. medical drugs, medical devices and equipment, sterilisation of reusable products and laundering, reprocessing, repair)
9.6 National representative bodies
9.7 Government
9.8 Academics