A Modified Step-Up Approach to Elective Laparoscopic Cholecystectomy Safely Reduces Cost and Carbon Impacts.

Abstract

Background: Contemporary surgery expends often excessive quantities of consumables, resulting in high cost and carbon footprint. This study examined the cost and carbon impacts of elective laparoscopic cholecystectomy (ELC), a common procedure involving near-universal disposable equipment, and whether a modification of approach to minimising these consumables can safely reduce these impacts, alongside rationalised antibiotic and venous thromboembolism (VTE) prophylaxis according to validated risk scoring instead of routine use.

Methods: The modified step-up approach to ELC involved rationalised antibiotic and VTE prophylaxis, a minimal operative set-up, and opening of further equipment only as required. Consecutive patients undergoing ELC by this approach by a single surgeon across four metropolitan hospitals, both public and private, were prospectively audited over 12 months, and compared with a retrospective audit of a matched cohort treated by the same surgeon using a custom laparoscopic kit in a previous 12-month period. Primary outcomes were operating time, cost, weight, and carbon footprint of consumables from the custom laparoscopic kit. Secondary outcomes included post-operative complications and length of stay.

Results: Compared with the previous standard approach, the modified step-up approach significantly reduced weight of surgical consumables by 51.9%, carbon footprint by 50.6%, and cost by 43.1%, without increasing operating time, complications or length of stay.

Conclusion: This modified step-up approach to ELC demonstrates how rethinking common surgical practice can reduce consumable waste, carbon footprint, and costs, without compromising patient safety and outcomes or increasing operating time.