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

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

Impacts of air pollutants on vegetation in developing countries

The predicted increases in emissions of primary pollutants in many rapidly industrializing countries may have severe consequences for the health and productivity of forest trees and agricultural crops. This paper presents a review of air pollution impacts on vegetation in developing countries by summarising information describing the direct impacts to vegetation caused by a number of air pollutants (sulphur dioxide (SO2), nitrogen oxides (NOx), ozone (O3) and Suspended Particulate Matter (SPM)). This information has been collected by experts from a number of rapidly industrializing countries in Asia, Latin America and Africa and includes observations of visible injury in the field and the use of transect studies and controlled experimental investigations to ascribe damage to different pollutant concentrations. The ability to synthesise this information to define exposure-response relationships and subsequent air quality guidelines similar to those established in North America and Europe is assessed. In addition, the use of regional and global models describing pollution concentrations is discussed with reference to assessing the extent of adverse impacts and identifying regions likely to be most at risk from air pollution, both for the present day and in the future. The evidence summarised in the paper clearly shows that current pollutant concentrations experienced in many developing countries, particularly Asia, can result in severe damage to vegetation and that without appropriate control measures such damage is likely to worsen in the future as pollutant emissions increase