A summary of the position paper appears below.

RACS' Recommendations

RACS supported the call of the Lancet Commission on Climate and Health for the health community in New Zealand to take a leadership role in advocating for emissions reductions. RACS recommends surgeons and hospitals consider the principles of effective waste management to take suitable steps to reduce the impact of surgery on the environment.

One suggested approach is to implement initiatives underpinned by the 5 Rs:

• Reduce
• Reuse
• Recycle
• Rethink
• Research

Reducing the impact of surgical practice on the environment

The delivery of health care has a considerable carbon footprint. A study published in 2018 estimated that health care in Australia contributes to 7 per cent of the entire country’s CO2e emissions, with around half of this contribution coming from hospitals alone. While no equivalent study has been conducted in New Zealand, it is likely that the figure is similar. Comparable findings have been made with regards to health care in the United States (10%) and in England (4%).

Surgical practice in particular has a large impact on the environment. Although occupying only a relatively small physical portion of a hospital, operating theatres produce around 20 per cent - 30 per cent of an institution’s waste. As this waste often needs to also undergo high-energy processing before it is safe for disposal, operating theatres, along with their heating, ventilation and air conditioning requirements, are estimated to be between three to six times more energy intensive than the rest of the hospital.

Anaesthetic gases, many of which are ozone-depleting, also contribute significantly to the carbon footprint of the operating theatre. As only 5 per cent - 20 per cent of anaesthetic gases are metabolised by patients, without recovery systems, the majority of remaining gases are released into the atmosphere. These gases can have a global warming potential over 2000 times that of carbon dioxide.

Due to being one of the most resource-intensive areas of the hospital, strategies which target the operating theatre have the potential to have the highest impact within the health-care industry. However, it is essential that initiatives which reduce the impact that surgical practice has on the environment do not compromise patient safety or quality of care.

Research conducted by Smith and Maddern (2014) on surgery and climate change proposed that the impact of anaesthetic gases on the environment could be mitigated by a combined strategy of reducing, reusing and recycling. Kagoma Y. et al (2012) also proposed an efficient waste management approach, summarising as the 5Rs: Reduce, Reuse, Recycle, Rethink, and Research. These basic principles of waste minimisation can also be effectively applied to wider operating theatre, and represent a straight-forward means of reducing the environmental impact of surgical practice.

Read the complete position paper at the link below.