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Green Surgery

Reducing the environmental impact of surgical care

Read the Report

The Green Surgery Report is a landmark report that presents the first detailed account of how to reduce the environmental impact of surgical care while maintaining high quality patient care and potentially saving the NHS money.

Executive Summary

Key insights and takeaways from the Green Surgery Report



Actions stakeholders can take to reduce the carbon footprint of surgical care


Case Studies

Examples of change efforts to reduce the carbon footprint of surgical care



Why take action to reduce the carbon footprint of surgical care?


Reduce the need for Surgery

Prevention of surgical disorders will reduce carbon emissions


Surgical Care Pathways

Interventions across care pathways can reduce environmental impact


Operating Theatres

Energy efficiency in operating theatres can reduce the environmental impact of surgical care



Finding low emissions substitutes for, and improving the efficiency of inhaled anaesthetics


Surgical Care Products

Applying circular economy principles to reduce the environmental impact of surgical products


Barriers and Facilitators

Mapping barriers to and facilitators of efforts to reduce the carbon footprint of surgical care


Future Research

Expanding the evidence base for effective action to reduce the carbon footprint of surgical care



Additional details about data and literature cited in the Green Surgery Report


What are key stakeholders saying about the report?

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.

Mahmood Bhutta, Professor of Sustainable Healthcare at Brighton and Sussex Medical School

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.

Dr Chantelle Rizan, Clinical Lecturer at Brighton and Sussex Medical School

At a time of planetary environmental crisis, we can find hope through action. This report identifies evidence-based, practical actions for all members of the surgical team to reduce surgery’s environmental harms while safeguarding or improving care for patients. The case studies throughout the report provide inspiring examples of what can be achieved by front-line staff working together with patients and colleagues.

Dr Frances Mortimer, Medical Director at the Centre for Sustainable Healthcare

Climate change is the leading threat to global health, and the NHS itself is a major carbon emitter, producing roughly the same greenhouse gas emissions as Denmark. Achieving net zero will require big changes to how care is delivered. While promising action is underway, clinical care needs a much greater focus. The Health Foundation is proud to have funded the UK Healthcare Alliance on Climate Change’s comprehensive guide to the decarbonisation of surgical care. It identifies actions for stakeholders from the operating theatre to far beyond, tackling one of the most carbon-intensive areas of healthcare.

Jennifer Dixon, Chief Executive of the Health Foundation

Clinicians and managers can take positive steps to reduce the burden of healthcare on the planet and the Green Surgery Report is an essential document to inform and guide these actions. The report is well researched and referenced, addressing the key carbon hotspots in hospitals, and, like the National Green Theatre Programme in NHS Scotland, provides detailed guidance to aid implementation of these essential improvements.

Kenneth Barker, Clinical Lead, National Green Theatres Programme
Chair, Environment and Sustainability Committee of Association of Anaesthetists

We were delighted to support the development of this groundbreaking report which so clearly sets out the challenge ahead for greener surgery. It will provide opportunities for our members to innovate their products and services and allow us as a Coalition to further develop our thinking on sustainable procurement, circularity and our care pathway approach to surgery.

Dr Fiona Adshead, Chair of the Sustainable Healthcare Coalition

This report represents a very significant body of work to which Royal College of Surgeons in Ireland is pleased to have contributed and provides the best current available evidence to reduce carbon emissions resulting  from surgical practice.

Here in Ireland, The Health Service Executive is committed to achieving net zero emissions by no later than 2050 and delivering healthcare which is environmentally and socially sustainable. This report provides a tool for all health service staff working in the surgical field to work towards achieving this. RCSI will promote its use across the HSE to reduce the environmental impact of surgical care and will ensure it is embedded in both undergraduate and post graduate surgical training for students and surgical trainees.

Prof Debbi Stanistreet, Head of Public Health and Epidemiology at the Royal College of Surgeons in Ireland

The Green Surgery Report delivers a much needed analysis on the environmental impact of surgical care. This evidence base must now be taken to drive holistic change to surgical services and ensure that they are both sustainable and of the highest standards. The recommendations are feasible to adopt for those across the spectrum of surgical services. Surgical trainees must be at the forefront to grasp this opportunity and help shape the change in practice that will benefit the environment and their patients.

Srinivas Cheruvu, President, Association of Surgeons in Training

There is an imperative for climate action to protect health, and this initiative is an excellent first step. By drawing in our healthcare providers as well as institutions it is a start to holding ourselves accountable for our present and future health.

Natasha Abdul Aziz, Royal College of Obstetrics & Gynaecology, Sustainable Healthcare Steering Committee

Royal Australasian College of Surgeons is very pleased to have been part of the process developing this report. It provides vital information and a blueprint for surgical organisations and teams internationally to take an evidence-based approach to reducing the environmental impact of surgery while maintaining the highest standards of patient care.

Dr Ben Dunne, Thoracic Surgeon, Royal Australasian College of Surgeons

The Report not only specifies further work to be done, but also describes some ideas that can be taken up straight away. The NHS target for net zero is a world leader. The Report can help achieve this aim for the benefit of the world, the nation, the NHS, the public and patients. Time is running out for the health of the planet. Leadership through this Report to achieve green surgery would be a great start!

Bob Evans, Spokesperson for the public and patients at the Centre for Perioperative Care

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 health care, including surgical practice, to net zero, and we need to provide training and career paths for researchers.

Richard Smith, Chair at the UK Health Alliance on Climate Change

The Green Surgery Report was produced by

Brighton & Sussex Medical School is fully committed to the principles of the General Medical Council’s Outcomes for Graduates. The school endorses the value of medical education in a multi-professional context, and promotes the highest possible standards in our teaching, clinical practice, and research (both fundamental and applied).

The Centre for Sustainable Healthcare (CSH) is a registered charity that develops knowledge and resources to support the NHS and other health systems to reach net zero carbon and wider sustainability.

The UK Health Alliance on Climate Change coordinates action, provide leadership, and amplify the voice of health professionals across the UK.

The Green Surgery Report was funded by

The Health Foundation focuses on improving people’s health and reducing inequalities, supporting radical innovation and improvement in health and care services, and providing evidence and analysis to improve health and care policy.

Report Oversight Committee

The production of the Report was supported by an oversight committee involving representatives of several key professional organisations involved in the delivery of surgical care. Oversight committee members advised on the structure and aims of the report, and provided valuable feedback on composing and reviewing contents.


The Green Surgery Report has been endorsed by the following organisations.

Equality Impact Assessment

Read the Equality Impact Assessment Statement for the Green Surgery Report here.

Additional Resources

Green Theatre Checklist

A practical checklist and compendium of evidence to support surgical teams in development of sustainable surgery


HealthcareLCA Database

An up-to-date centralised public repository of healthcare environmental impact data and resources


JLA Priority Setting Partnerships

A top ten list from JLA of research questions that should be addressed to help surgery become more environmentally sustainable