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

A Classification System for Colombian Wetlands: an Essential Step Forward in Open Environmental Policy-Making

Knowledge about the distribution and diversity of wetlands has become an essential tool for environmental management and policy-making. Yet, while recent estimates indicate that 27% of the area of Colombia is covered by wetlands and despite a number of regional studies, information about the diversity of wetlands nationally is scarce. In response, we present a national wetland classification system that is based on an ecological approach, from the perspective of wetland scientists, and which builds upon the assumptions underlying the flood pulse concept and hydrogeomorphic approach. Thus, the approach and structure of the Brazilian wetland classification system are used, with geomorphological adjustments made according to Colombia’s topography. The classification is hierarchical, multi-scale, functional, and organized according to four levels (system, macroregion, subsystem, and class), with the wetland diversity of Colombia represented nationally by 89 macrohabitats across marine-coastal, inland, and anthropogenic systems. The primary purpose of this classification is to provide integrated and organized information on the distribution and diversity of Colombian wetlands that will serve as a baseline for transparent environmental policy-making