
==== Front
Int J Surg
Int J Surg
JS9
International Journal of Surgery (London, England)
1743-9191
1743-9159
Lippincott Williams & Wilkins Hagerstown, MD

38814282
IJS-D-24-02103
10.1097/JS9.0000000000001723
00133
3
Correspondence
A commentary on ‘Barriers and facilitators to sustainable operating theatres: a systematic review using the Theoretical Domains Framework’
Li Xue MB ubeyou@sina.com
*
Xie Xiaorui MB 850183129@qq.com

Department of Anesthesiology, Aerospace Central Hospital, Beijing, People’s Republic of China
* Corresponding author. Address: Department of Anesthesiology, Aerospace Central Hospital, Beijing 100049, People’s Republic of China. Tel.: +135 110 747 68. E-mail: ubeyou@sina.com (X. Li).
9 2024
29 5 2024
110 9 60096010
16 5 2024
19 5 2024
Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc-nd/4.0/

OPEN-ACCESSTRUE
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pmc Dear Editor,

Climate change has been declared by the World Health Organization to be the most significant public health threat of the 21st century1. Its manifestations have various impacts on health, altering the burden of disease and placing a disproportionate burden on marginalized and low-income populations. There is mounting evidence that lung cancer, asthma, allergies, heat waves, and air pollution all worsen cardiovascular disease, asthma, and the susceptibility of infectious diseases to spread. Recommendations for evaluating the environmental effect of healthcare are included in the 2015 care pathways advice from the Sustainable Healthcare Coalition. Interestingly, operating rooms account for a significant portion of the emissions related to the provision of healthcare, being ‘three to six times more energy-intense than the hospital as a whole.’ Identifying carbon hotspots unique to surgery might make it easier to develop targeted therapies.

In order to determine the obstacles and enablers of behaviours that lessen the environmental effect of operating rooms, Almukhtar et al.2 conducted a review, and 18 themes across 10 Theoretical Domains Framework (TDF) domains were determined. Adoption of green behaviours in operating rooms was most frequently hampered by issues with ‘environmental resources and context’, ‘knowledge’, ‘beliefs about consequences’ and ‘social influences’. Generally, intention served as the facilitator.

The carbon hotspots that have been found highlight the harmful consequences that medical consumables and equipment may have on the environment3. Further research revealed that the carbon footprint associated with the transportation of these commodities is rather tiny, and logistical improvements are unlikely to have a major impact. Reusable or hybrid products can be utilized in place of single-use ones to reduce emissions related to this hotspot. Furthermore, adequate waste sorting might maximize the amount of material that can be reprocessed and minimize the volume that is sent for autoclaving or burning.

Reducing emissions from power consumption can involve practices like turning off lights and appliances and allowing climate control systems to wander across a broader temperature range when not in use. Another possible energy-saving strategy in the operating room is laminar airflow4; however, a meta-analysis found no advantage of laminar airflow over traditional turbulent ventilation in lowering the risk of surgical site infections5.

While there are now guidelines available for determining carbon footprints, none of them are tailored specifically to surgical procedures. The procedures that are included in the inventory boundaries of a surgical operation vary and differ between researches. It will be critical for researchers in this emerging field to establish international guidelines that identify the boundaries of the inventory in order to allow for comparisons between studies and to enhance the generalizability of the results. Even while inventory boundaries are standardized, different approaches used to compute individual processes also produce different findings and conclusions. In order to lead us toward more sustainable, ‘greener’, surgical practice, it is crucial to regulate these confounding factors to identify the most effective surgical procedures.

Ethical approval

None.

Consent

None.

Sources of funding

None.

Author contribution

X.L.: wrote; X.X.: study design.

Conflicts of interest disclosure

There are no conflicts of interest.

Research registration unique identifying number (UIN)

None.

Guarantor

Xue Li.

Data availability statement

This is a letter; a data statement is not required.

Provenance and peer review

None.

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Published online 29 May 2024
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References

1 Reis S Morris G Fleming LE . Integrating health and environmental impact analysis. Public Health 2015;129 :1383–1389.24099716
2 Almukhtar A Batcup C Bowman M . Barriers and facilitators to sustainable operating theatres: a systematic review using the Theoretical Domains Framework. Int J Surg 2024;110 :554–568.37889570
3 Malik A Lenzen M McAlister S . The carbon footprint of Australian health care. Lancet Planet Health 2018;2 :e27–e35.29615206
4 Erichsen AA Petzold M Bergh I . Comparison between mixed and laminar airflow systems in operating rooms and the influence of human factors: experiences from a Swedish orthopedic center. Am J Infect Control 2014;42 :665–669.24713595
5 Bischoff P Kubilay NZ Allegranzi B . Effect of laminar airflow ventilation on surgical site infections: a systematic review and meta-analysis. Lancet Infect Dis 2017;17 :553–561.28216243
