The healthcare sector, paradoxically, is a significant contributor to global carbon emissions, even as it addresses the health impacts of climate change. Surgical care, in particular, stands out as a major emitter of greenhouse gases (GHG) within hospitals, accounting for 30–40% of all healthcare carbon emissions globally and up to three to six times higher than other hospital departments.
A groundbreaking systematic review by Kloevekorn et al. (2024), titled “Decarbonizing surgical care: a qualitative systematic review guided by the Congruence Model,” delves deep into this critical issue. The study utilized a comprehensive qualitative systematic literature review, guided by the Congruence Model – a powerful conceptual lens that analyzes organizational elements (Work, People, Culture, and Structure) to understand performance and facilitate change.
Key findings from this insightful research include:
- Identified Emission Hotspots: The review pinpoints major sources of direct carbon emissions in surgical care, including:
- Anesthetic gases, especially desflurane, which can account for up to one-third of total operating room (OR) GHG emissions and have a global warming potential up to 2,000 times greater than CO2.
- Discarded unused surgical supplies and equipment, with up to 22.6% of items in custom packs being wasted.
- Sterilization procedures, which generate significant carbon emissions (e.g., re-sterilizing a generic hand set can produce 14.1 kg of CO2).
- The high carbon footprint of robotic surgery, which can be up to eight times higher than conventional methods.
- Organizational Drivers of Emissions: Using the Congruence Model, the study links these emission hotspots primarily to the Work (operational tasks) and People (individual behaviors and competencies) elements. For instance:
- Lack of awareness and knowledge among clinicians regarding the environmental impact of their daily work is a significant factor.
- Habitual behaviors and resistance to change prevent surgical staff from adopting more sustainable practices, even when aware of their environmental impact.
- Structural Solutions are Key: Most identified sustainability measures are categorized under the Structural element of the Congruence Model, highlighting the necessity for systemic change and policy adjustments. These measures include:
- Incentivizing the use of reusable supplies and equipment over disposables, which has shown significant positive impacts on carbon footprint and even financial savings.
- Implementing policies for waste segregation and recycling, especially for biohazardous waste, which often gets mixed with recyclable materials leading to high environmental and cost implications.
- Minimizing the required supplies and equipment in the OR through lean philosophy and optimized custom pack designs.
- Substituting high-impact anesthetic agents like desflurane with lower GHG options such as sevoflurane, which can reduce emissions by over 25%.
- Investing in training and education programs to raise awareness and equip staff with the skills for sustainable practices.
Addressing Incongruencies for Effective Change: The study emphasizes that successful decarbonization efforts require addressing incongruencies between these elements. For example, policies encouraging sustainability will falter if staff lack the awareness, knowledge, or training to implement them effectively, or if deeply embedded cultural values like “patient care over environmental care” are not addressed. Hospital management must strategically integrate sustainability, ensuring resources are available to facilitate behavioral changes and align structural policies with the culture and practices of their OR staff.
This research offers a valuable framework for healthcare institutions and policymakers to understand, diagnose, and strategically target carbon emissions within surgical care, paving the way for more sustainable and environmentally responsible hospital operations.
Reference:
Kloevekorn, L., Roemeling, O., Fakha, A., Hage, E., & Smailhodzic, E. (2024). Decarbonizing surgical care: a qualitative systematic review guided by the Congruence Model. BMC Health Services Research, 24(1), 1456. https://doi.org/10.1186/s12913-024-11929-6.
