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

A Knowledge Formalization Approach for Manufacturing Cost Estimation

Target pricing is a methodology to develop competitive products by determining the target price from market analyses. To guarantee the right profit margin, target cost is a direct consequence of target price. In this situation, the manufacturing cost estimation at the design phase becomes an essential task. The paper presents a framework for collecting knowledge required for estimating manufacturing cost of components. The framework consists of: (i) a cost break-down structure used for splitting manufacturing costs, (ii) a data model for col-lecting that knowledge required for defining manufacturing processes, (iii) a data model for the collecting that knowledge required for computing the manufactur-ing cost of each operation within a manufacturing process and (iv) a workflow for analytically estimating cost of components. The framework has been mainly conceived for managing components realized through forming and shaping pro-cesses. The result presented in this paper guarantee the following benefits: (i) knowledge elicitation on product manufacturing cost, (ii) knowledge sharing among design/engineering departments, and (iii) knowledge capitalization for de-cision-making process