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 características da carcaça de novilhos terminados em pastejo rotacionado ou em confinamento

Foram avaliados o desempenho e as características de carcaça de 36 novilhos Brahman (Bh), Brangus (Bg) e Hereford adaptado (He), terminados em pastejo com suplementação (PSu) ou em confinamento (Conf). Os animais foram abatidos quando apresentavam espessura de gordura maior do que 4mm. Na dieta do Conf, a relação volumoso:concentrado foi de 60:40 (com base na matéria seca), continha 13% de proteína bruta (PB) e 62% de nutrientes digestíveis totais (NDT). O capim-mombaça continha, em média, 7% de PB e 54% de NDT, e o suplemento 24% de PB e 76% de NDT. Foi observada diferença (P<0,05) no sistema de terminação para o ganho de peso médio diário, com 1,200kg/cab/dia para Conf e 0,675kg/cab/dia para Psu. Os novilhos Bh e Bg pesaram, em média, 445,8kg, e o rendimento da carcaça quente foi de 58,4%, valores maiores que os 399,1kg e 55,4% obtidos pelos animais He. A área de olho de Longissimus foi maior para os animais Bg, 76,42cm². A maciez, 3,71 vs 4,89, e a espessura de gordura subcutânea, 4,64 vs 3,39, foram melhores nos animais terminados em Conf do que nos animais em Psu, respectivamente