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

Estudi, anàlisi i modelització de l'estructura del One World Trade Center de Minoru Yamasaki per mitjà de SAP2000

[ES] La finalidad del trabajo consiste en el análisis de la estructura del One World Trade Center, la torre norte de las conocidas Torres Gemelas, diseñadas por el arquitecto japonés-americano Minoru Yamasaki. La construcción de estas torres supuso una revolución en la construcción de los edificios en altura, convirtiéndose de 1971 a 1973 en uno de los edificios más altos del mundo. Se empleó el sistema de tubo estructural, que concentra el entramado de acero de alta resistencia en las fachadas del edificio. Este se convierte en fundamental para controlar la estabilidad lateral del edificio ante el factor que más afecta al diseño estructural de los rascacielos, el viento. La utilización de elementos prefabricados permitió una reducción importante del coste y tiempo de construcción, elevando así, una cantidad de espacio rentable superior a cualquier edificio contenido en el skyline de Manhattan hasta la fecha. Se analizará el arquitecto, contexto, obra y el sistema estructural empleado. El análisis estructural se realizará mediante el programa informático SAP 2000, realizando previamente un modelo con AutoCAD con los detalles y simplificaciones necesarias que se asemejen lo más posible a la realidad estructural. Mediante la herramienta SAP2000 se obtendrán los resultados del análisis del cual se realizarán las conclusiones del modelo y el comportamiento de la estructura del edificio.[EN] The objective of the work is to analyze the structure of the One World Trade Center, the north tower of the well-known Twin Towers, designed by the Japanese-American architect Minoru Yamasaki. The construction of these towers was a revolution in the construction of high-rise buildings, becoming from 1971 to 1973 in one of the tallest buildings in the world. It employed the structural tube system, which concentrates high-strength steel framing on the building's facades. This becomes essential to control the lateral stability of the building in the factor that most affects the structural design of skyscrapers, the wind. The use of prefabricated elements allowed for a significant reduction in cost and construction time, thus elevating an amount of rentable space superior to any building contained in the Manhattan skyline to date. The architect, context, construction site and the structural system employed will be analyzed. The structural analysis will be carried out using the computer program SAP 2000, previously making a model with AutoCAD with the necessary details and simplifications that are as close as possible to the structural reality. The SAP 2000 tool will be used to obtain the results of the analysis from which we will obtain the conclusions of the model and the behavior of the building's structure.Eiras Calvo, S. (2022). Estudio, análisis y modelización de la estructura del One World Trade Center de Minoru Yamasaki mediante SAP2000. Universitat Politècnica de València. http://hdl.handle.net/10251/19080

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care