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

Integrated risk assessment due to slope instabilities in the roadway network of Gipuzkoa, Basque Country

Transportation corridors such as roadways are often subjected to both natural instability and cut-slope failures, with substantial physical damage to the road infrastructure and threats to the circulating vehicles and passengers. In the early 2000s, the Gipuzkoa Provincial Council of the Basque Country in Spain noted the need for assessing the risk related to the geotechnical hazards of its road network, in order to assess and monitor their safety for road users. The quantitative risk assessment (QRA) was selected as a tool for comparing the risk of different hazards on an objective basis. Few examples of multi-hazard risk assessment along transportation corridors exist. The methodology presented here consists of the calculation of risk, in terms of probability of failure and its respective consequences, and it was applied to 84 selected points of risk (PoR) over the entire road network managed by the Gipuzkoa Provincial Council. The types of encountered slope instabilities that are examined are rockfalls, retaining-wall failures, and slow-moving landslides. The proposed methodology includes the calculation of the probability of failure for each hazard based on an extensive collection of field data, and its association with the expected consequences. Instrumentation data from load cells and inclinometers were used for the anchored walls and the slow-moving landslides, respectively. The expected road damage was assessed for each hazard level in terms of a fixed unit cost (UC). The results indicate that the risk can be comparable for the different hazards. A total of 21¿% of the PoR in the study area were found to be of very high risk.Peer Reviewe

Hydrophobic Eutectogels as Electrodes for Underwater Electromyography Recording

Underwater recording remains a critical challenge in bioelectronics because traditional flexible electrodes can not fulfill essential requirements such as stability and steady conductivity in aquatic environments. Herein, we show the use of elastic gels made of hydrophobic natural deep eutectic solvents as water-resistant electrodes. These eutectogels are designed with tailorable mechanical properties via one-step photopolymerization of acrylic monomers in different eutectic mixtures composed of fatty acids and menthol. The low viscosity of the eutectics turns the formulations into suitable inks for 3D printing, allowing fast manufacturing of complex objects. Furthermore, the hydrophobic nature of the building blocks endows the eutectogels with excellent stability and low water uptake. The obtained flexible eutectogel electrodes can record real-time electromyography (EMG) signals with low interference in the air and underwater.This work was supported by Marie Sklodowska-Curie Research and Innovation Staff Exchanges (RISE) under grant agreement No 823989 (“IONBIKE”). M.L.P. gratefully acknowledges the financial support from the European Union’s Horizon 2020 research and innovation program under the Marie Sklodowska-Curie grant agreement no. 101028881. A.D.A. acknowledges UPV/EHU for funding transferred by the European Union-Next Generation EU by the Margarita Salas fellowship. (MARSA N° agreement 22/77)

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care. We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care