Sanjna Gangakhedkar, Stanley Chen, Tommy Thio Sulputra, Mahdid Azam, Zachary Jelbart, Oliver McCahill
{"title":"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。","authors":"Sanjna Gangakhedkar, Stanley Chen, Tommy Thio Sulputra, Mahdid Azam, Zachary Jelbart, Oliver McCahill","doi":"10.1111/ans.70223","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>","PeriodicalId":8158,"journal":{"name":"ANZ Journal of Surgery","volume":" ","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A Modified Step-Up Approach to Elective Laparoscopic Cholecystectomy Safely Reduces Cost and Carbon Impacts.\",\"authors\":\"Sanjna Gangakhedkar, Stanley Chen, Tommy Thio Sulputra, Mahdid Azam, Zachary Jelbart, Oliver McCahill\",\"doi\":\"10.1111/ans.70223\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>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.</p>\",\"PeriodicalId\":8158,\"journal\":{\"name\":\"ANZ Journal of Surgery\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-06-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"ANZ Journal of Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1111/ans.70223\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"ANZ Journal of Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1111/ans.70223","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"SURGERY","Score":null,"Total":0}
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.
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.