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

Corticosteroids

Corticosteroids are among the most widely prescribed drug classes globally. The corticosteroid market is projected to be worth more than USD 10 billion annually. Corticosteroids, which include glucocorticoids and mineralocorticoids, are synthetic analogs of the natural steroid hormones produced by the adrenal cortex. Glucocorticoids are predominantly influence cellular metabolism and have immunosuppressive, anti-inflammatory, and vasoconstrictive effects, whereas mineralocorticoids regulate electrolytes and water balance by affecting ion transport in the epithelial cells of the renal tubules. They are used to treat conditions such as: asthma, allergic rhinitis, and hay fever, urticaria (hives) atopic eczema, chronic obstructive pulmonary disease (COPD), painful and inflamed joints, muscles and tendons, lupus, inflammatory bowel disease (IBD)—including Crohn\u27s disease, ulcerative colitis, giant cell arteritis and polymyalgia rheumatica and multiple sclerosis (MS). Corticosteroids can also be used to replace certain hormones that are not being produced by the body naturally—for example, in people with Addison\u27s disease. However, long-term use of corticosteroids leads to serious and disabling toxic effects. Few of them are listed here: elevated ocular pressure (glaucoma), cataracts formation, round face (moon face), high blood sugar (can trigger or worsen diabetes), increased risk of microbial infections, thinning of bones (osteoporosis), suppression of hormone production by the adrenals (that can result in severe fatigue, loss of appetite, nausea, and muscle weakness, thinning of skin, bruising and slower wound healing). The most effective way to combat toxic situations is to withdraw the medication, and provide supportive care with adequate medical consultation.https://nsuworks.nova.edu/hpd_facbooks/1003/thumbnail.jp

Dicarboxylic Acid

Dicarboxylic acids are organic compounds that contain two functional carboxylic acid (–COOH) groups. Industrially, they are important in producing polyester, polyols, polyamides, and nylon and as a precursor to active pharmaceutical ingredients and additives. Dicarboxylic acids are important water-soluble components of atmospheric aerosols. Succinic, adipic, and glutaric acid may be harmful if inhaled, swallowed, or absorbed through the skin. All these acids alone or in combination do not show any mutagenic effect. Some of the dicarboxylic acids (sebacic acid) have been advocated to have an anti-hyperglycemic effect, whereas analysis of serum-free fatty acids from patients with Reye\u27s syndrome (acute encephalopathy with visceral steatosis syndrome) had revealed the presence of dicarboxylic acids in over half of the patients\u27 total free fatty acids; both medium-chain (6–12 carbon lengths) and long-chain (14–18 carbon lengths) dicarboxylic acids were identified in such studies. Malathion, a well-known organophosphate pesticide, was previously marketed as malathion dicarboxylic acid, is fetotoxic and toxic to infants and children.https://nsuworks.nova.edu/hpd_facbooks/1002/thumbnail.jp