Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

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

Knee osteoarthritis increases pain perception and alters interleukins (6 and 10) levels in patients in South-West, Nigeria

Background: Osteoarthritis is a chronic degenerative joint disease which can affect any joint in the body, usually accompanied by pain. The onset and progression of the disease is determined by several factors such as genetic, gender, occupation and ethnicity. There is paucity of information on pain perception and biochemical profile in Osteoarthritis of the knee (KOA) patients in Nigeria.Objective: To assess the pain perception and some biomarkers in osteoarthritic patients in South-west, Nigeria.Design: A retrospective studySetting: Nationally representing South-West region of NigeriaSubjects: A total of sixty human adult subjects were used in this study (Control group, 30 healthy and KOA group, 30 diagnosed with OA) Main outcome measures: All the subjects underwent the Ischemia-induced pain test and blood samples were taken from them for the determination of serum interleukin-6 (IL-6), interleukin-10 (IL-10) and calcitonin gene related peptide (CGRP).Results: The results showed a significantly (p<0.05) higher pain threshold and pain tolerance in healthy individuals compared to KOA patients. There was also a significantly (p<0.05) elevated level of IL-6 in the serum of KOA patients compared to control (13.0 ± 0.7 vs 20.1±3.2 pg/dl) and a significantly (p<0.05) lower level of IL-10 in the serum of OA patients compared to control (14.3± 3.1 vs 4.1 ±0.5 pg/dl).Conclusion: There was no difference in the serum level of CGRP in the control compared with the KOA group. In conclusion, KOA causes decrease in pain tolerance and threshold which is accompanied by alteration in vital biochemical parameters