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

Comparison of maps of spatial variability of soil resistance to penetration constructed with and without covariables using a spatial linear model Comparação de mapas de variabilidade espacial da resistência do solo à penetração construídos com e sem covariáveis usando um modelo espacial linear

A study about the spatial variability of data of soil resistance to penetration (RSP) was conducted at layers 0.0-0.1 m, 0.1-0.2 m and 0.2-0.3 m depth, using the statistical methods in univariate forms, i.e., using traditional geostatistics, forming thematic maps by ordinary kriging for each layer of the study. It was analyzed the RSP in layer 0.2-0.3 m depth through a spatial linear model (SLM), which considered the layers 0.0-0.1 m and 0.1-0.2 m in depth as covariable, obtaining an estimation model and a thematic map by universal kriging. The thematic maps of the RSP at layer 0.2-0.3 m depth, constructed by both methods, were compared using measures of accuracy obtained from the construction of the matrix of errors and confusion matrix. There are similarities between the thematic maps. All maps showed that the RSP is higher in the north region.<br>Realizou-se um estudo sobre a variabilidade espacial de dados de resistência do solo à penetração (RSP), nas camadas de 0,0-0,1 m, 0,1-0,2 m e 0,2-0,3 m de profundidade, utilizando métodos estatísticos em forma univariada, isto é, utilizando a geoestatística tradicional, construindo os mapas temáticos por krigagem ordinária para cada camada em estudo. Foi analisada a RSP na camada de 0,2-0,3 m de profundidade por meio de um modelo espacial linear (SLM), em que se consideraram as camadas de 0,0-0,1 m e 0,1-0,2 m como covariáveis, obtendo um modelo de estimação e um mapa temático por krigagem universal. Os mapas temáticos da RSP da camada de 0,2-0,3 m de profundidade, construídos por ambos os métodos, foram comparados por meio de medidas de acurácia obtidas a partir da construção da matriz de erros e da matriz de confusão. Verificou-se semelhança entre os mapas temáticos. Todos os mapas mostraram que a RSP é mais alta na região norte