Investigating the Sustainability of Urological Surgery: A Retrospective Analysis.

Abstract

Climate change is the major health concern of the 21st century, and paradoxically, healthcare is one of the leading contributors to global warming. This study intends to investigate how urology can reduce its carbon footprint. A review of the literature highlighted how energy consumption - through air conditioning in particular - medical waste, and anaesthetic gases are the main causes of emissions from the theatre. A retrospective analysis of the number of general anaesthetics (GAs) and anaesthetic gases used for all urological procedures over one month was conducted using electronic records. A questionnaire was provided to 30 theatre staff, assessing their insight into the carbon footprint of the department. It investigated waste management and engagement with the issue of the climate crisis. An analysis of the current waste streams and the amount of waste produced was also conducted. Thirty-nine operations were done under GA, with sevoflurane used in 48% (n = 30) of all cases, and desflurane used in 3% (n = 7). Education and appropriate recycling facilities were identified as key areas within waste management that needed addressing. Clinical waste produced 850 tonnes per year at this Trust; domestic waste production was 725 tonnes per year; and recycling produced 160 tonnes of cardboard and 9 tonnes of plastic bottles. Discussion with the waste minimisation officer led to a planned introduction of a new waste stream into theatres. Poor staff knowledge on waste disposal and the new waste stream introduction was addressed with an in-person educational update on waste disposal. Second-cycle results showed a large improvement in staff scores prior to the new waste stream introduction. This study identifies simple measures that can be introduced to greatly reduce the carbon footprint of urological operations. Energy consumption can be reduced with efficient theatre management, air conditioning awareness, and appropriate waste streams. Furthermore, the implementation of a well-structured educational programme, and readily available recycling bins, addresses high levels of inappropriate waste disposal.