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Sustainable surgery: the first "net zero" operation in the NHS

Published on 25/05/2022

Zero carbon surgery

The surgical team discuss the significance and impact of the first recorded net zero operation in the NHS.

Today we're doing the world's first net zero operation.

But this is only the beginning: we need to ensure that the measures that we put in place maintain the safety for every patient undergoing surgery in the NHS, and also that there's no effect on the capacity of operating theatres during the COVID recovery effort.

Research is one of the useful tools we use to ensure this. We want to do a study across the NHS to engage theatre teams to understand why there are barriers in changing practice towards making theatres more green, and to ensure that patient safety is maintained during those processes.

Surgery is imperative for maintaining the health of the population as a whole. As we are recovering from the COVID pandemic and restarting our operations, it is important that we are able to do this efficiently and do this with sustainability in mind.

Operating rooms generate more carbon than any other area of the hospital, which is why we think it's really important to evaluate what can be done to reduce carbon emissions from the operating room.

Today, we're hoping to do the first documented carbon neutral operation in the NHS, and we're hoping that will be a starting point for creating standard operating procedures whereby everybody can adopt relatively simple processes that nudge us in the right direction towards a carbon neutral future.

To achieve a net zero operation and to become a green operating theatre, we need to work with quite a big team of people that includes surgeons, anaesthetists and the wider theatre team - and we definitely need to involve the patient.

So to do this across operating theatres, in our hospital, of which there at least 50, is quite a complex task. We need green champions to lead the way in healthcare. And these are people who feel passionately about the topic, who can provide the leadership that's needed to bring people together to create green operating.

So in the future, with our green operating theatre, I hope that this is something that we can just achieve routinely on a daily basis throughout the NHS and beyond across the world as well.

A surgical team at University Hospitals Birmingham NHS Foundation Trust has completed the first documented "net zero" operation in the NHS - with the patient discharged safely and recovering well from a keyhole procedure to remove a bowel cancer.

Performed at Solihull Hospital, the operation introduced several changes to the team’s normal practice:

  • Using reusable gowns, drapes, and scrub caps
  • Giving medications through the veins for general anaesthesia rather than anaesthetic gases, which have a strong greenhouse effect
  • Implementing a plan for minimising electricity use, including heating and lighting
  • Recycling of single-use equipment used in surgery, working with industry partners
  • Recycling of "clean" paper and plastic waste
  • Using individually packed equipment, and only opening items as they were required
  • One consultant surgeon ran to hospital, and the other cycled

This first net zero operation combines evidence-based approaches and documents using a carbon output calculator developed specifically for this task by experts, led by Dr Dmitri Nepogodiev, at the University of Birmingham.

UHB Consultant Surgeon and Senior Lecturer at the University of Birmingham Mr Aneel Bhangu said: “Operating theatres are resource intensive environments, contributing to 25% of the Trust’s carbon output.

“We cannot achieve net zero health systems without making surgery more green, so this is a vital proof of concept step.

“Ensuring healthcare is environmentally friendly is important to patients and communities.

“These measures require changes in behaviour and care pathways across complex teams.

“We now hope to work with colleagues across the UK to create a wider impact across the whole NHS.”

The net zero operation involved all members of the team including the surgeons, anaesthetists, nurses, cleaners, porters, and managers.

Tim Jones, Chief Innovation Officer at UHB, added: “I would like to thank Aneel and his colleagues for their work on delivering the first net zero operation in the NHS.

“As a large NHS organisation, we know UHB has a significant carbon footprint, but we are committed to reducing this as much as possible whilst still providing the care and treatment our patients need.

“I hope this net zero operation is the first of many, not just at UHB but across the NHS.”

At the end of the operation, the team used the calculator to estimate the reduction in carbon output for the operation compared to the usual output. They calculated that the carbon output was reduced by almost 80%, with the remaining output then offset this through a variety of verified carbon offsetting projects, including the planting of trees in the grounds of Solihull Hospital. This brought the total carbon output for the operation to net zero.

Safety and efficiency were maintained for the patient throughout, carried out within a full, day-long operating list, including surgery for three other patients.

The NHS contributes 6% of the UK’s total carbon footprint, and COP26 targets will not be achieved without moving towards a more sustainable future in healthcare. Operating theatres are an important focus – making up as much as 25% of hospitals’ contribution, despite less than 5% of hospital in patients undergoing surgery.

As the NHS COVID-19 recovery plan for elective surgery is introduced and doctors across the NHS look to increase the volume of elective surgery, measures such as these will ensure that the impact on the planet is kept to a minimum.

Patient advocate and research involvement lead Dr Lesley Booth CBE said: “Reducing the environmental impact of surgery is hugely important to improving health more broadly. We know that climate change and air pollution has wide impacts on health, many of which aren’t measurable until years to come. I would want my operation in a hospital that cares about the environment, showing its commitment to patients and public health.”

Further net zero operations are planned at UHB in the coming weeks.

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