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

Incidència, mesures de prevenció i particularitats de la reparació de l'hèrnia incisional de l'orifici del tròcar laparoscòpic

Es realitza estudi observacional que descriu una incidència d’ HIOT (Hèrnia incisional de l'orifici del tròcar) del 23,7%. L’edat>70 anys, el IMC ≥30 i la mida de la incisió són factors de risc per a HIOT. La incidència real de HIOT és superior a la descrita. Es realitza un assaig clínic prospectiu randomitzat que conclou que la utilització d’una malla supraaponeuròtica profilàctica no disminueix la incidència de HIOT de forma estadísticament significativa en comparació amb el tancament simple del tròcar umbilical (27,4 vs 34,7%; p = 0,594). S’observa mitjançant un estudi transversal basat en el registre nacional EVEREG que aquells pacients intervinguts per a la reparació d’una hèrnia incisional (HI) de localització umbilical (M3), intervinguts prèviament per cirurgia oberta, presenten més complicacions (21,9 vs. 14,6%) i recidives que aquells intervinguts prèviament per via laparoscòpica.An observational study is carried out. It describes an (TSIH) (Trocar Site Incisional Hernia) incidence of 23,7%. Age>70 years, BMI ≥30 and incision size are identified as risk factors for TSIH. The current incidence of TSIH is higher than that previsously described. A randomized clinical trial is conducted. It concludes that the use of a prophylactic supraaponeurotic mesh would not decrease the incidence of TSIH compared to simple closure of the umbilical trocar (27,4 vs 34,7%; p = 0,594). It is observed through a cross-sectional study based on the EVEREG national registry that those patients who were operated for reparation of an umbilical IH (Incisional hernia) (M3), previously intervened by open surgery, present more complications (2,.9 vs. 14, 6%) and relapses than those who were previously operated on laparoscopically