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

Potassium Source and Biofertilizer Influence K Release and Fruit Yield of Mango (<i>Mangifera indica</i> L.): A Three-Year Field Study in Sandy Soils

Arid degraded soils have a coarse texture and poor organic matter content, which reduces the activity of microorganisms and soil enzymes, and thus the soil quality, plant yield and quality decrease. Potassium solubilizing bacteria (KSB) have been suggested to increase the activity of soil enzymes and increase the release of potassium from natural K-feldspar in the arid degraded soil, and thus potentially reduce the rates of the application of chemical fertilizers. Field studies were conducted for three successive growing seasons in an organic farming system to investigate the effects of K-feldspar and KSB (Bacillus cereus) on K release, soil fertility, and fruit yield of mango plants (Mangifera indica L.). The maximum growth of mango plants was found in the treatments inoculated with KSB. KSB increased soil available N, P, K, and the activity of dehydrogenase and alkaline phosphatase enzymes by 10, 7, 18, 54, and 52%, respectively. KSB increased the fruit yield of mango by 23, 27, and 23% in the first, second, and third growing seasons, respectively. The partial (up to 50%) substitution of chemical K-fertilizer with K-feldspar gave fruit yield and quality very close to that fertilized with the full chemical K-fertilizer. The release rate of K (over all the treatments) varied between 0.18 and 0.64 mg kg−1 of soil per day. KSB significantly increased the K release rate. The application of chemical K-fertilizer gave the highest K release, while substitution with K-feldspar reduced the release of K. Natural K-feldspar contains 8.2% K but is poorly soluble when applied alone. KSB increased the soil quality parameters and enhanced the growth and quality of mango fruit. The fruit yield of mango, under KSB inoculation and fertilization with different K sources, ranged between 9.14 to 17.14 t ha−1. The replacement of 50% of chemical K-fertilizer with natural K-feldspar caused a decrease in the fruit yield by 17, 8, and 2.7% in the first, second, and third years, respectively. The substitution of chemical K-fertilizer with K-feldspar up to 50% with KSB is a good strategy to reduce the excessive use of chemical K-fertilizer. B. cereus and natural K-feldspar have the potential to improve soil health and mango plant productivity in low fertile arid soils

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population