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

Is Anterior Bridge Plating for Mid-Shaft Humeral Fractures a Suitable Option for Patients Predominantly Involved in Overhead Activities? A Functional Outcome Study in Athletes and Manual Laborers

BACKGROUND: To assess the functional and radiological outcomes of minimally invasive anterior bridge plating (ABP) for mid-shaft humerus fractures in patients predominantly involved in overhead activities (athletes and manual laborers). METHODS: Forty-eight patients fulfilling inclusion criteria were treated with ABP at a level-I trauma center using a 4.5-mm dynamic/locking compression plate and followed for a period of 1 year. Functional outcome was assessed using the Constant, Mayo elbow, and Disabilities of the Arm, Shoulder and Hand (DASH) scores. Range of motion (ROM), subjective strength, and radiographic union were assessed. A general satisfaction questionnaire was also administered. RESULTS: Most patients achieved excellent functional and radiological outcomes. ROM and strength of the shoulder girdle exhibited clinically nonsignificant loss as compared to the opposite side. The mean time for return to the original activities was 64 days (range, 36 to 182 days) and the mean time for confirmed radiographic union was 45 days (range, 34 to 180 days). The mean Constant, Mayo elbow, DASH scores were 95.73 ± 5.76 (range, 79 to 100), 95.94 ± 6.74 (range, 85 to 100), and 1.56 ± 3.15 (range, 0.0 to 14.0), respectively. The majority of patients (43 patients, 89.6%) who fell in the excellent or very good category according to our questionnaire were extremely satisfied. There were 2 cases (4.17%) of nonunion and 3 patients (6.25%) had to change/modify their original occupation. CONCLUSIONS: ABP is fundamentally different from traditional open posterior plating or conventional intramedullary nailing. It gives relative stability with union taking place by callus formation, and a longer plate on the tensile surface ensures that the humerus can withstand greater amount of rotational and bending stresses. The minimally invasive nature causes minimal soft tissue damage and, if done correctly, causes no damage to the vital structures in proximity. ABP for mid-shaft humerus fractures in patients predominantly engaged in overhead activities is a safe and effective treatment modality yielding high rates of union, excellent functional recovery, minimal biological disruption, better cosmesis, and superior satisfaction rates