Key messages

1. There is limited published evidence on which to base informed decisions on interventions aimed at reducing the environmental impact of surgical operating theatres.

2. Reducing the environmental impact of surgery often requires a reduction in resource use, which in turn can lead to reduced costs. Interventions intended to improve environmental sustainability may incur an upfront cost (for example, the purchase of reusable surgical equipment), though they will likely be cost saving in the long term.

3. Primary prevention of surgical conditions, through patient education and empowerment, dietary advice and lifestyle changes, can greatly reduce the carbon footprint of surgery. When surgery is required, using environmentally sustainable approaches such as low-carbon treatments, reusables, recycling and maintaining equipment should be adopted where possible and clinically appropriate.

4. Small changes in practice can lead to environmental sustainability improvements. Examples from the literature include use of low-flow anaesthesia to reduce waste, turning off idle machines to reduce electricity use, using reusable equipment where possible and reviewing and streamlining theatre packs to reduce waste.

5. Barriers to improvements in sustainable practice include lack of leadership, limited knowledge of best practice and day-to-day workload pressures.

6. Future studies assessing the impact of different surgical approaches or models of care on sustainability should consider environmental impacts alongside other important factors such as patient outcomes and costs. Our Scottish Health Technologies Group (SHTG) Evidence Framework can be used to guide the collection of relevant data to inform decision making.

Referred by

National Green Theatres Programme