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

Die NiTiBOND®-Stapesprothese als vielversprechende Neuentwicklung in der Otosklerosechirurgie

Ein wesentliches Detailproblem der Stapesplastik ist die Befestigung der Stapesprothese am langen Ambossfortsatz. Um dieses Problem des "Crimping" zu lösen, wurden in den letzten Jahren verschiedene neuartige Prothesentypen entwickelt, die sich ohne manuelle Verformung der Prothese am Amboss befestigen lassen. Einen Vertreter dieser innovativen Prothesentypen stellt die NiTiBOND®-Prothese dar, ein Implantat aus der Formgedächnislegierung Nitinol, dessen Schlinge sich durch fokussierte Applikation von Laserenergie kontrolliert und schrittweise um den langen Ambossfortsatz modellieren lässt und so der individuellen Ambossgeometrie Rechnung trägt. Eine vergleichende Untersuchung der NiTiBOND®-Prothese, der K-Piston-Prothese und der à-Wengen-Clip-Prothese in unserer Klinik zeigt, dass sich bei Verwendung dieser neuartigen Stapesprothese eine größere Abnahme der Schallleitungskomponente sowie eine geringere postoperative Restschallleitungskomponente erzielen lassen. Darüber hinaus ermöglicht es die NiTiBOND®-Prothese auch erfahrenen Ohroperateuren ohne langjährige Erfahrung in der Stapeschirurgie, gute postoperative Hörergebnisse zu erreichen. Dies ist insbesondere auf dem Hintergrund der in Deutschland zurückgehenden Zahl an Stapesoperationen von Bedeutung. Großer Hörgewinn und leichtere Handhabbarkeit charakterisieren diese Stapesprothese als vielversprechende Neuentwicklung für die Otosklerosechirurgie.Der Erstautor gibt keinen Interessenkonflikt an

Impact of comorbidity and anemia in patients with oropharyngeal cancer primarily treated with surgery in the human papillomavirus era.

Background: Comorbidity and anemia strongly influence treatment and outcome of oropharyngeal squamous cell carcinomas (SCCs), but respective data are frequently lacking in clinical studies. We evaluated 149 cases of oropharyngeal SCC primarily treated with surgery regarding the impact of these factors on disease-free survival (DFS) and overall survival (OS). Methods: Data were recorded during treatment and follow-up visits. Human papillomavirus (HPV) association of oropharyngeal SCC was detected by p16 immunohistochemistry. Results: Patients with p16-positive disease were significantly less comorbid and anemic, and treated more aggressively. Comorbidity and anemia, but not p16 status, significantly influenced DFS and had more impact on OS than p16 status. Conclusion: In our study, p16-positive seems a good surrogate marker for healthier patients. Patients with p16-positive disease showed improved survival, but this was limited to none/mild comorbid and/or nonanemic individuals in this group. On the basis of our results, we strongly suggest the inclusion of these factors in risk stratification for clinical studies