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

Sustained Release of Vitamin D3 Enhanced Osseointegration Capacity: An Experimental Sheep Study

Abstract: This study aimed to investigate the effect of sustained-release vitamin D loaded in poly-lacticacid (PLA) nanoparticles and applied to grafting materials around titanium (ti) dental implants.A total of 48 implants were inserted into the standardized bone defects created in the iliac crest of 6sheep, divided into 4 different experimental sites (empty control, autografted, xenografted, andautograft + xenografted). Vitamin D3, which was encapsulated by PLA nanoparticles, was preparedand applied in half of the defects and left to heal for 3 and 6 weeks. New bone formation (NBF%) andbone-implant contact (BIC%) values were evaluated by histologic and histomorphometric analyses (P< 0.05). Nanoparticles with a yield of 80.30% ± 2.14% and high encapsulation efficiency of 72.99% ±2.20% were achieved. In all sections, osseointegration was observed, with no signs of inflammation,necrosis, or foreign body reaction. NBF% and BIC% were significantly higher in vitamin D3–loadedgroups (P < 0.001). In both healing periods, the highest NBF% and BIC% have been recorded in theautograft + xenograft groups. (For the respective third and sixth weeks: the NBF% was 49.63 ± 1.53and 74.25 ± 0.96, and BIC% was 54.26 ± 0.66 and 82.59 ± 2.09, respectively; P < 0.001). Sustainedreleaseof vitamin D loaded into the PLA system demonstrated high biocompatibility, favorablesustained release of vitamin D3, and improved NBF% and BIC% around ti implants placed in boxshapedsheep iliac crest defects. Further investigations are required for their clinical applicability.Keywords: autograft; dental implant; osseointegration; poly-lactic acid; sustained release; vitamin D3;xenograft