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

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

The Utility of Gas Under Diaphragm on Radiograph in Patients with Perforated Appendix

Background To evaluate the diagnostic utility of gas under the diaphragm on abdominal radiograph for patients with a perforated appendix. Methods A prospective, observational study at General Surgery Department, Jinnah Postgraduate Medical Centre, Karachi, Pakistan was conducted between 2018 to 2020. All patients with suspected appendicitis, irrespective of gender were included in the study. Patients with age younger than 12 years or older than 60 years were excluded from the study. Findings from the imagings for each patient were noted. The plain radiograph was looking for “Gas under diaphragm”. All imaging was performed by a radiologist with experience of five years or more. All data were entered into a statistical package for social sciences (SPSS version 24). Results The appendix diameter was highly significantly associated with the risk of perforation in patients with appendicitis (p&lt;0.001). Similarly, the patients with a perforated appendix have a significantly higher white blood cell count compared to those without perforation (15.6 ± 5.1 versus 13.2 ± 4.4; p-value = 0.002). It was found that out of the 76 patients with perforated appendicitis pneumoperitoneum was positive in 6 (7.8%) patients while out of those with a non-perforated appendix, 8 (10.5%) had gas under the diaphragm. Conclusion Gas under the diaphragm on a plain radiograph was detected in only a few cases with perforated appendicitis. Nevertheless, if positive, it warrants immediate abdominal surgery and requires comprehensive investigation.</jats:p

Comparison Of Diclofenac Suppository with Injection Tramadol In Postoperative Pain

Pain and damage to tissue structure is frequently observed after surgical procedures. Management of postoperative pain has always been remained a challenge to surgeons because of its detrimental effect on patient’s satisfaction, early mobilization and regaining of functionality. Objective: To compare the analgesic efficacy of diclofenac suppository with injection tramadol 100 mg for postoperative pain relief after abdominal surgeries. Methods: This Randomized Double-Blind Controlled Trial was conducted upon a sample of 98 patients, aged 12 to 60 years and undergoing abdominal surgery (elective and emergency) divided into two groups (Group A: Diclofenac Suppositories 100 mg, and Group B: Injection Tramadol 100 mg), of 49 patients each. Visual Analogue Scale (VAS) was used for measuring the severity of pain at 0, 1, 6, 12, 18 and 24 hours, following surgeries. Results: The mean age of the sample stood at 31 (SD ± 03) years, with most of the sample comprising of males (72.45%). Postoperative pain was experienced by patients in both groups, with group A reporting less severe pain than group B but no statistical difference was found between the severity. Conclusion: After careful consideration, it may be concluded that both agents, namely Diclofenac Suppositories 100 mg, and Injection Tramadol 100 mg are efficacious at managing the postoperative pain hence both may be used interchangeably or in conjunction among patients undergoing abdominal surgeries.</jats:p

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