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

A three-dimensionally preserved fossil polychaete worm from the Silurian of Herefordshire, England.

Polychaete body fossils are rare, and are almost invariably compressed and too poorly preserved for meaningful comparison with extant forms. We here describe Kenostrychus clementsi gen. et sp. nov. from the Silurian Herefordshire Konservat-Lagerstätte of England, in which three-dimensional external morphology is preserved with a fidelity unprecedented among fossil polychaetes. The fossils, which are preserved in calcite, were serially ground and photographed at 30 microm intervals to produce computer-generated reconstructions of the original external surface. The new genus has a generalized polychaete morphology with large biramous parapodia, unspecialized anterior segments and a small prostomium with median and lateral antennae and ventral prostomial palps. Cirriform branchiae arise from the ventral surface of each notopodium, and may be homologous with the inter-ramal branchiae of the extant nephtyids. Through cladistic analysis, Kenostrychus is interpreted as a member of a stem group of either the Phyllodocida or the Aciculata (Phyllodocida + Eunicida). Direct comparison with other fossil forms is difficult, but hints that inter-ramal respiratory structures may be primitive within the Phyllodocida and/or the Aciculata