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

Site predilection of extrapulmonary tuberculosis: study from a tertiary care centre

Background: Extrapulmonary tuberculosis (EPTB) still constitutes an important clinical problem. We aimed to evaluate the site prevalence of extrapulmonary tuberculosis.Methods: We retrospectively evaluated 187 extrapulmonary tuberculosis patients diagnosed between 1st June 2013 and 31st May 2015 in a tertiary care hospital, Kanpur, Kerala, India.Results: Among the extra pulmonary tuberculosis 112 (59.9%) were males. About 170 (90.9%) patients received CAT1 treatment and 17 (9%) patients received CAT2 treatment. Overall, the total number of different types of EPTB cases included Lymph node (n=55, 29.41%), GIT (n=45, 24.04%), Pleura (n=44, 23.53%), Skeletal (n =14, 7.49%), CNS (n=7, 3.74%) EPTB cases other site included mainly genitourinary (6), breast (6), skin (5), pericardium (3), Psoas (4) a vocal cord (1) and eye (1).Conclusions: EPTB still constitutes an important clinical problem. In the current study, we assessed the site of predilection of EPTB patients. In this study, EPTB cases constituted 52.08% of all tuberculosis cases presented to our center in the study period. Lymph node tuberculosis is the most common type