This article is more than 5 years old. Information may no longer be current.
Innovative approaches may reduce carbon footprint and environmental impact of surgery
Click Here to Manage Email Alerts
In the cover story on the high carbon footprint of cataract surgery as performed in the developed world, we are made aware of a growing problem for the planet. It appears to be a combination of waste from packaging of things such as IOLs and disposable gowns and single use of pharmaceuticals but also transport to and from the hospital for patients and staff and the items used in cataract surgery. A number of studies are cited to demonstrate how the carbon footprint figures are arrived at and how in some institutions, such as the Aravind group of hospitals in India, this might be significantly reduced.
There are many issues raised about the use of reusable instruments at a time when in many hospitals single-use instruments are becoming the norm. There have been economic studies done comparing reusable and single-use instruments for cataract surgery, which have come down in favor of the latter, but no account will have been taken of the carbon footprint.
It is suggested that we should be able to emulate the low carbon footprint of the Aravind hospitals by reusing gowns and instruments, washing gloves between cases and using two operating tables in the same theater. At the same time, instruments could be quickly autoclaved and not dried between cases, only going through a full cycle at the end of each day. This is all justified by the very low infection rate reported at Aravind, which compares favorably with that in the United Kingdom and the United States. While this might be possible in a high-volume Asian setting, current regulations and surgeon and patient acceptance in the United Kingdom or United States could be a major issue standing in the way. However, there are some ways that things could certainly be improved to minimize the carbon footprint.
Better arrangements for assessing and processing patients to minimize the visits to the hospital for their surgery would help. One approach that has been demonstrated to be cost-effective is same-day bilateral surgery. Although this is considered in many countries as unacceptable, it has been performed in Finland for many years. It certainly reduces the journeys to the hospital very considerably.
The issue of excessive packaging and information inserts is raised in the article, taking as an example the very information booklets found in IOL packaging. These are there for regulatory reasons only. Nobody ever reads them, and they are immediately binned as the IOL is opened by the circulating nurse. The containers for irrigating fluid are often in plastic bags rather than glass bottles, which could be recycled, but of course there is the matter of collecting the empty bottles and the fuel used to do this.
One of the studies referred to in the article states that small-incision surgery, presumably manual, has a lower carbon footprint than phacoemulsification. I do not think that it is very likely in the developed world that people would start to perform small-incision extracapsular cataract surgery because of a lower carbon footprint.
In the end, whatever is done to address this issue will be a balance between a rationalization of current practice to minimize waste and innovative approaches to improve movement of patients, surgeons and goods required for our surgery.
- For more information:
- Richard B. Packard, MD, FRCS, FRCOphth, OSN Europe Edition Board Member, can be reached at Arnott Eye Associates, 22a Harley St., London W1G 9BP, England; email: eyequack@vossnet.co.uk.
Disclosure: Packard reports no relevant financial disclosures.