Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Ductus arteriosus aneurysm presenting as hoarseness: successful repair with an endovascular approach

An aneurysm of the ductus arteriosus is a rare finding, particularly in the adult population. These saccular aneurysms arise at the site of an incompletely obliterated ductus arteriosus along the lesser curvature of the aortic arch. Left untreated, it is associated with a high risk of potentially life-threatening complications including rupture, infection and thromboembolism. As a result, surgical correction is recommended. Previously, options were limited to open repair but as endovascular experience grows, novel techniques afford safer and less invasive alternatives. In contrast, neonatal ductus arteriosus aneurysms may regress spontaneously and expectant treatment can be justified. We present the case of a 74-year-old woman who presented with hoarseness secondary to a ductus arteriosus aneurysm; a diagnosis consistent with Ortner's syndrome. The patient underwent an uncomplicated endovascular repair using the chimney-graft technique

Ductus arteriosus aneurysm presenting as hoarseness: successful repair with an endovascular approach

An aneurysm of the ductus arteriosus is a rare finding, particularly in the adult population. These saccular aneurysms arise at the site of an incompletely obliterated ductus arteriosus along the lesser curvature of the aortic arch. Left untreated, it is associated with a high risk of potentially life-threatening complications including rupture, infection and thromboembolism. As a result, surgical correction is recommended. Previously, options were limited to open repair but as endovascular experience grows, novel techniques afford safer and less invasive alternatives. In contrast, neonatal ductus arteriosus aneurysms may regress spontaneously and expectant treatment can be justified. We present the case of a 74-year-old woman who presented with hoarseness secondary to a ductus arteriosus aneurysm; a diagnosis consistent with Ortner's syndrome. The patient underwent an uncomplicated endovascular repair using the chimney-graft technique

Ductus arteriosus aneurysm presenting as hoarseness: successful repair with an endovascular approach

An aneurysm of the ductus arteriosus is a rare finding, particularly in the adult population. These saccular aneurysms arise at the site of an incompletely obliterated ductus arteriosus along the lesser curvature of the aortic arch. Left untreated, it is associated with a high risk of potentially life-threatening complications including rupture, infection and thromboembolism. As a result, surgical correction is recommended. Previously, options were limited to open repair but as endovascular experience grows, novel techniques afford safer and less invasive alternatives. In contrast, neonatal ductus arteriosus aneurysms may regress spontaneously and expectant treatment can be justified. We present the case of a 74-year-old woman who presented with hoarseness secondary to a ductus arteriosus aneurysm; a diagnosis consistent with Ortner\u27s syndrome. The patient underwent an uncomplicated endovascular repair using the chimney-graft technique

C-Reactive Protein-Lymphocyte Ratio Identifies Patients at Low Risk for Major Morbidity after Oesophagogastric Resection for Cancer

&lt;b&gt;&lt;i&gt;Introduction:&lt;/i&gt;&lt;/b&gt; Complications following oesophagogastric surgery have significant implications for patient recovery. &lt;b&gt;&lt;i&gt;Objective:&lt;/i&gt;&lt;/b&gt; identify cost-effective biomarkers which can predict morbidity. &lt;b&gt;&lt;i&gt;Methods:&lt;/i&gt;&lt;/b&gt; Analysis of all upper gastrointestinal resections in Galway University Hospital from 2014 to 2018 was performed. The ability of C-reactive protein (CRP), neutrophil-lymphocyte ratio (NLR), and CRP-lymphocyte ratio (CLR) to predict morbidity, including anastomotic leak (AL), was assessed and compared. &lt;b&gt;&lt;i&gt;Results:&lt;/i&gt;&lt;/b&gt; Seventy-one oesophagectomies and 77 gastrectomies were performed. There were 2 (1%) 30-day mortalities and 83 (56%) morbidities of which 30 (20%) were of Clavien-Dindo grade 3 or higher. The rate of major morbidity within the oesophagectomy cohort was 27% and was 14% in the gastrectomy cohort. There were 11 (7%) ALs, 7 in the oesophagectomy cohort, and 4 in the gastrectomy cohort. From post-operative day (POD) 2 onwards, CRP could predict AL (POD2 AUC = 0.705, &lt;i&gt;p =&lt;/i&gt; 0.025; POD3 AUC = 0.757, &lt;i&gt;p&lt;/i&gt; = 0.005, POD4 AUC = 0.811, &lt;i&gt;p&lt;/i&gt; = 0.001; and POD5 AUC = 0.824, &lt;i&gt;p&lt;/i&gt; = 0.001). CLR predicted AL on POD2 onwards (POD2 AUC = 0.722, &lt;i&gt;p&lt;/i&gt; = 0.005; POD3 AUC = 0.736, &lt;i&gt;p =&lt;/i&gt; 0.01; POD4 AUC = 0.775, &lt;i&gt;p&lt;/i&gt; = 0.003; and POD5 AUC = 0.817, &lt;i&gt;p&lt;/i&gt; = 0.001). CRP level of 218 mg/dL and CLR level of 301 at POD 2 generated negative predictive values of 97 and 98%, respectively, for AL. Post-operative NLR did not display sufficient discriminatory ability for the outcomes. &lt;b&gt;&lt;i&gt;Conclusion:&lt;/i&gt;&lt;/b&gt; CRP and CLR are reliable negative predictors of major morbidity, including AL, after oesophagogastric resection. Their use can inform patient intervention and recovery. </jats:p

Employment and labour aspects of the national plan

The four papers in this symposium were originally presented at the Fifth Annual Economic Policy Conference of the Dublin Economics Workshop held in Killarney on October 15-17 1982 and are published together in this Policy Paper with only minor alterations. Taken together, they illustrate the complexity of the issues which must be faced in devising an exchange-rate policy as well as the diversity of views held by economists on the subject.A hard copy is available in UCD Library at GEN 330.08 IR/UN

Employment and labour aspects of the national plan

The four papers in this symposium were originally presented at the Fifth Annual Economic Policy Conference of the Dublin Economics Workshop held in Killarney on October 15-17 1982 and are published together in this Policy Paper with only minor alterations. Taken together, they illustrate the complexity of the issues which must be faced in devising an exchange-rate policy as well as the diversity of views held by economists on the subject.A hard copy is available in UCD Library at GEN 330.08 IR/UN