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

Desempenho e digestibilidade aparente dos nutrientes em ovinos alimentados com dietas contendo bagaço de cana-de-açúcar tratado com óxido de cálcio Performance and nutrients apparent digestibility in sheep fed diets containing sugar cane bagasse treated with calcium oxide

Foram estudados os efeitos da adição de 0,0; 0,75; 1,5 e 2,25% de óxido de cálcio no bagaço de cana-de-açúcar (com base na matéria natural) com o objetivo de avaliar o desempenho, o consumo de nutrientes e a digestibilidade aparente das dietas e dos nutrientes em ovinos mestiços da raça Santa Inês e raças nativas. Vinte e quatro ovinos, mantidos em total confinamento, foram distribuídos em delineamento inteiramente ao acaso, com quatro níveis de óxido de cálcio e seis repetições. Os animais foram mantidos em baias individuais, por 77 dias. Os primeiros 14 dias foram de adaptação e, então, seguiram-se três períodos de 21 dias de coleta de dados. Na determinação da digestibilidade, utilizou-se o método de coleta total de fezes, que foi realizada nos quatro últimos dias do período experimental. As fezes foram coletadas três vezes ao dia, às 7, 13 e 18 h. O uso do óxido de cálcio não influenciou os consumos de matéria seca, proteína bruta, fibra em detergente neutro, fibra em detergente ácido e nutrientes digestíveis totais, mas houve efeito linear sobre ganho de peso, com o aumento nas doses de óxido de cálcio, mas não sobre a conversão alimentar e os coeficientes de digestibilidade aparente da matéria seca, proteína bruta e fibra em detergente ácido. Entretanto, foi observado efeito quadrático para o coeficiente de digestibilidade aparente da fibra em detergente. A utilização do bagaço de cana hidrolisado com óxido de cálcio em níveis a partir de 1,5% da matéria natural promove melhoras no desempenho de ovinos e aumenta a digestibilidade apenas da fibra em detergente neutro.<br>The addition effects of 0.0; 0.75; 1.5 and 2.25% of calcium oxide on sugar-cane bagasse (on natural matter basis) were studied to evaluate the performance, nutrients intake and apparent digestibility of the diets and nutrients in crossbred sheep of Santa Inês and native breeds. Twenty-four sheep, maintened in total confinement, were assigned in a completely randomized experimental design, with four levels of calcium oxide and six repetitions. Animals were kept in individual pens for 77 days. The first 14 days were for animals adaptation and three periods of 21 days of data collection. The method of total fecal collection was used to estimate digestibility, which was carried in four days at the end of the experimental period. Feces were collected three times a day, at 7 am, 1 and 6 pm. The intake of dry matter, crude protein, neutral detergent fiber, acid detergent fiber and total digestible nutrients were not influenced by the use of calcium oxide. There was a linear effect in daily weight gain with increasing calcium oxide dose. However, there was no treatment effect on feed conversion and apparent digestibility coefficients of dry matter, crude protein and acid detergent fiber. Whereas the quadratic effect was observed for neutral detergent fiber apparent digestibility coefficient. The use of the hydrolized sugar cane bagasse with calcium oxide, from 1.5%, promote increase in performance of sheep and increase digestibility in neutral detergent fiber