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

Factores de riesgo cardiovascular en el ritmo circadiano del infarto agudo de miocardio

Introducción y objetivos. El objetivo de este trabajo es analizar la influencia de los factores de riesgo cardiovascular modificables en el ritmo circadiano del infarto agudo de miocardio. Pacientes y método. Análisis retrospectivo de 54.249 pacientes incluidos en la base de datos del proyecto ARIAM con diagnóstico de infarto agudo de miocardio. Se analizan las variables hora de inicio, edad, sexo, cardiopatía isquémica previa, estado en el momento del alta de la unidad coronaria, antecedentes familiares de cardiopatía isquémica, accidente cerebrovascular previo, hipertensión arterial, dislipemia, diabetes, tabaquismo y reinfarto. El análisis de ritmo se ha efectuado utilizando un test simple de igualdad de series basado en el análisis cosinor de múltiples sinusoides, eligiendo 3 armónicos (24,12 y 8 h) para su ajuste. Resultados. La hora de inicio del infarto muestra ritmo circadiano (p < 0,01) con pico a las 10,07 y valle a las 4,46 h. Todos los subgrupos categorizados por la presencia de las variables analizadas presentaron ritmo circadiano, con una curva ajustada de aspecto sinusoidal. Los pacientes con diabetes, reinfarto y tabaquismo muestran una curva sinusoidal de aspecto bimodal. Conclusiones. El infarto agudo de miocardio presenta ritmo circadiano. La diabetes, el tabaquismo y el reinfarto pueden modificar el ritmo habitual de aparición del infart