Carbon footprint of non-melanoma skin cancer surgery

Background: Climate change poses a significant global health threat and healthcare, including surgery, contributes to greenhouse gas emissions. Efforts have been made to promote sustainability in surgery, but the literature on sustainability in plastic surgery remains limited. Methods: A life-cycle analysis was used to assess and quantify the environmental emissions associated with three distinct reconstructive methods utilized in non-melanoma skin cancer surgery: direct closure, split-thickness skin graft, and full-thickness skin graft. Analyses were conducted in March 2023 in Morriston Hospital, Swansea, UK. The carbon footprints for non-melanoma skin cancer surgery in England and Wales were then estimated. Results: The mean carbon emissions for non-melanoma skin cancer surgery ranged from 29.82 to 34.31 kgCO₂eq. Theatre energy consumption (4.29–8.76 kgCO₂eq) and consumables (16.87 kgCO₂eq) were significant contributors. Waste produced during non-melanoma skin cancer surgery accounted for 1.31 kgCO₂eq and sterilization of reusable surgical instruments resulted in 1.92 kgCO₂eq of carbon emissions. Meanwhile, transportation, dressings, pharmaceuticals, and laundry accounted for 0.57, 2.65, 1.85, and 0.38 kgCO₂eq respectively. The excision of non-melanoma skin cancer with direct closure (19.29–22.41 kgCO₂eq) resulted in the lowest carbon emissions compared with excision with split-thickness skin graft (43.80–49.06 kgCO₂eq) and full-thickness skin graft (31.58–37.02 kgCO₂eq). In 2021, it was estimated that non-melanoma skin cancer surgery had an annual carbon footprint of 306 775 kgCO₂eq in Wales and 4 402 650 kgCO₂eq in England. It was possible to predict that, by 2035, carbon emissions from non-melanoma skin cancer surgery will account for 388 927 kgCO₂eq in Wales and 5 419 770 kgCO₂eq in England. Conclusion: This study highlights the environmental impact of non-melanoma skin cancer in plastic surgery departments and emphasizes the need for sustainable practices. Collaboration between surgeons and policymakers is essential and further data collection is recommended for better analysis