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

Did COVID outbreak influence our management of skin tumors?

Aim: COVID pandemic forced new medical protocols. COVID precautions also changed surgical algorithms causing a change in medical costs. This study aims to clarify COVID-era medical costs and underlying reasons for patients with Head & Neck (H&N) area skin tumors. Materials and Methods: Patients which were operated for H&N tumors in our clinic before and during the COVID outbreak were retrospectively analyzed per sex, age, etiology, PPE usage, treatments, and total costs. Statistical analysis was done for any significant changes. Results: A total of 127 patients of which 70 were operated before (G1) and 57 were operated after (G2) the COVID out-break for H&N tumors were evaluated. Mean ages were 69,94 years for G1 and 65,56 for G2. 28 BCC and 42 SCC patients were in G1 and 11 BCC and 46 SCC patients were in G2. In G1, 69 wide excisions, 44 skin graft, 17 skin flaps, 6 lymph node dissections (LNDs) were done. In G2, 56 wide excisions, 30 skin grafts, 9 skin flaps, 6 LNDs, 5 free flaps were done. G1 patients were hospitalized for a median of 2 days, while G2 patients were hospitalized for a median of 3 days. Median costs were $261,42 in G1 and$624.84 in G2. Statistical analysis with Mann-Whitney-U and Chi-Square tests revealed significant difference only between the costs. When disposable PPE was excluded, the median cost of G2 became $539.84 (G3). Statistical difference between G1 and G3 was found to be insignificant. Conclusion: COVID changed the etiology of our patient groups. However, our treatment protocols, hospitalization lengths, and costs remain the same. Our patient profile and treatment protocols remain similar, but COVID precautions add an extra burden

The impact of serum albumin-to-alkaline phosphatase ratio in cervical cancer patients treated with definitive chemoradiotherapy

We retrospectively analysed the prognostic significance of serum albumin, alkaline phosphatase (ALP) and albumin to ALP ratio (AAPR) and other prognostic factors affecting the overall survival (OS) and progression-free survival (PFS) in 200 cervical cancer patients treated with definitive chemoradiotherapy (CRT). The prognostic factors for OS and DFS, in addition to the predictive factors of albumin, ALP and AAPR, were investigated. Older age, lymph node metastasis, non-complete response (CR) to treatment and low serum albumin levels emerged as predictors of poor OS and PFS in multivariate analysis. However, with a cut-off value of 0.51, AAPR was not a significant prognostic factor of survival in multivariable analysis. There were no significant differences in clinicopathological factors between patients with low and high AAPR, except for lymph node metastasis, where lymph node metastasis rate was significantly higher in patients with a low AAPR compared to those with a high AAPR. Patients with CR had a significantly higher serum albumin level and AAPR compared to patients without CR. The pre-treatment serum albumin level was independent predictive for survival; therefore, it could be a suitable biomarker to guide systemic therapy and predict patient outcomes. Impact Statement What is already known on this subject? Two major determinants of tumour progression are nutritional status and inflammation. The albumin-to-alkaline phosphatase ratio (AAPR), which was originally proposed as a marker for nutritional status and immune response, was recently discovered to be a prognostic factor for various cancer types. However, its utility in the treatment of cervical cancer has not been established. What do the results of this study add? Low serum albumin levels were associated with a significantly shorter OS and PFS in cervical cancer patients treated definitively with CRT. AAPR, on the other hand, was not a significant prognostic factor for survival with a cut-off value of 0.51. Regional lymph node metastasis was significantly more common in patients with a low AAPR than in those with a high AAPR. What are the implications of these findings for clinical practice and/or further research? Patients with multiple clinicopathological risk factors and low serum albumin levels had an increased risk of disease recurrence and a poorer prognosis, highlighting the importance of additional adjuvant treatment strategies in these patients. Due to the preliminary nature of our findings, additional research is required to corroborate them