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

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

Evaluation of Muscle Quality Reliability and Racial Differences in Body Composition of Overweight Individuals

The purpose of this study was to evaluate the reliability of ultrasound measures of muscle cross-sectional area (mCSA) and echo intensity (EI) in overweight subjects. A secondary purpose was to evaluate racial differences in EI, mCSA and body composition. In 33 overweight subjects, mCSA and EI were determined from a panoramic ultrasound scan of the vastus lateralis. Body composition was determined using dual-energy X-ray absorptiometry (DXA). Reliability of mCSA and EI was calculated from the intra-class correlation coefficient (ICC), standard error of the measurement (SEM) and minimal difference (MD). The ICC, SEM and MD for mCSA and EI were 0.87, 2.12, 5.89 and 0.74, 4.58, 12.69, respectively. There were no significant racial differences in body composition (p > 0.05); however, EI was significantly lower for black subjects (p = 0.018). These results suggest ultrasound measures of mCSA and EI are reliable in overweight subjects, and EI may provide additional muscle composition evaluations, beyond DXA measures

Polychaetes (Annelida) of Cyprus (Eastern Mediterranean Sea): An Updated and Annotated Checklist including New Distribution Records

The diversity and distribution of polychaetes in the coastal area and the EEZ of the Republic of Cyprus is presented based on both the literature records and new data acquired in a wide range of environmental monitoring programmes and research projects. A total of 585 polychaete species belonging to 49 families were reported in Cyprus waters; among them, 205 species (34%) were recorded based on the literature only, 149 (26%) were new records based on our own data, and a total of 231 spp. (40%) were recorded from both the literature and new data. A total of 51 polychaete species were identified as non-indigenous; among them, 32 were confirmed as alien species, 4 were considered cryptogenic, and 15 were considered questionable as there were doubts about their identity. The Indo-Pacific Schistomeringos loveni was reported for the first time in the Mediterranean Sea, while four species already reported in the literature, namely, Bispira melanostigma, Fimbriosthenelais longipinnis Leonnates aylaoberi, and Rhodopsis pusilla, were added to the list of non-indigenous polychaetes in the Mediterranean Sea. The current work highlights the importance of implementing environmental monitoring programmes and carrying out research surveys targeting benthic macrofauna assemblages

Polychaetes (Annelida) of Cyprus (Eastern Mediterranean Sea): An Updated and Annotated Checklist including New Distribution Records

The diversity and distribution of polychaetes in the coastal area and the EEZ of the Republic of Cyprus is presented based on both the literature records and new data acquired in a wide range of environmental monitoring programmes and research projects. A total of 585 polychaete species belonging to 49 families were reported in Cyprus waters; among them, 205 species (34%) were recorded based on the literature only, 149 (26%) were new records based on our own data, and a total of 231 spp. (40%) were recorded from both the literature and new data. A total of 51 polychaete species were identified as non-indigenous; among them, 32 were confirmed as alien species, 4 were considered cryptogenic, and 15 were considered questionable as there were doubts about their identity. The Indo-Pacific Schistomeringos loveni was reported for the first time in the Mediterranean Sea, while four species already reported in the literature, namely, Bispira melanostigma, Fimbriosthenelais longipinnis Leonnates aylaoberi, and Rhodopsis pusilla, were added to the list of non-indigenous polychaetes in the Mediterranean Sea. The current work highlights the importance of implementing environmental monitoring programmes and carrying out research surveys targeting benthic macrofauna assemblages

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 coprioritized 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

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)