选择性腹腔镜胆囊切除术的改良进步式安全降低成本和碳影响。

IF 1.6 4区 医学 Q3 SURGERY
Sanjna Gangakhedkar, Stanley Chen, Tommy Thio Sulputra, Mahdid Azam, Zachary Jelbart, Oliver McCahill
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引用次数: 0

摘要

背景:当代外科手术耗材往往过多,导致高成本和碳足迹。本研究调查了选择性腹腔镜胆囊切除术(ELC)的成本和碳影响,这是一种涉及几乎普遍使用的一次性设备的常见手术,以及修改方法以尽量减少这些消耗品是否可以安全地减少这些影响,同时根据验证的风险评分来合理化抗生素和静脉血栓栓塞(VTE)预防,而不是常规使用。方法:改进的ELC升级方法包括合理的抗生素和静脉血栓栓塞预防,最小的手术设置,并仅在需要时开放进一步的设备。在四家公立和私立的大都市医院,由一名外科医生通过这种方法接受ELC的连续患者进行了为期12个月的前瞻性审计,并与在过去12个月期间由同一名外科医生使用定制腹腔镜套件治疗的匹配队列的回顾性审计进行了比较。主要结果是手术时间、成本、重量和自定义腹腔镜套件耗材的碳足迹。次要结果包括术后并发症和住院时间。结果:与原有标准入路相比,改良后的上坡入路手术耗材重量减少51.9%,碳足迹减少50.6%,成本减少43.1%,且未增加手术时间、并发症和住院时间。结论:这种改进的ELC升级方法展示了如何重新思考常见的手术实践可以减少耗材浪费、碳足迹和成本,而不会影响患者的安全和结果或增加手术时间。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Modified Step-Up Approach to Elective Laparoscopic Cholecystectomy Safely Reduces Cost and Carbon Impacts.

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.

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来源期刊
ANZ Journal of Surgery
ANZ Journal of Surgery 医学-外科
CiteScore
2.50
自引率
11.80%
发文量
720
审稿时长
2 months
期刊介绍: ANZ Journal of Surgery is published by Wiley on behalf of the Royal Australasian College of Surgeons to provide a medium for the publication of peer-reviewed original contributions related to clinical practice and/or research in all fields of surgery and related disciplines. It also provides a programme of continuing education for surgeons. All articles are peer-reviewed by at least two researchers expert in the field of the submitted paper.
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