The environmental impact of the health systems is on the table of many governments around the world. The objective is to reduce the negative impact on the environment. This aim can only be achieved with green surgery. Why? Because the operation room is the most energy and resources consuming area of a hospital. This topic was addressed in the last number of BJS by Dr. Dmitri Nepogodiev from the University of Birmingham, UK.
Green surgery is surgery with a near-zero carbon footprint and reduced surgical wastes, without impact on water and air pollution and land contamination. However, in the end, patients’ and surgical teams’ security always comes first, which makes some initiatives impossible to implement. Changes in sterile instrument packaging could eventually increase surgical site infections, and changes in anesthetic practice could increase postoperative pneumonia. Will green surgery be possible without risk for patients and surgeons?
Dmitri Nepogodiev says that large-scale studies are needed to evaluate the true impact of some identified interventions that could reduce carbon footprints, aiming at providing strong evidence to convince surgical teams. The feasibility of specific interventions should also be studied. Surgical teams should work with the industry to develop acceptable green solutions. One way is to find reusable alternatives for single-use energy devices. However, patients’ security must not be compromised. The danger of reusable equipment is the abuse use many hospitals stimulate to save money. Another idea is to adapt the value hospitals pay for a specific device. Being eco-friendly should become a crucial factor during the choosing process of which device/instrument a hospital will buy. Meaning only eco-friendly devices would be taken into consideration by all health systems.
The author says that telemedicine should be used to reduce patients' travels to hospitals, with the objective to reduce air pollution through unnecessary transportation. This would reduce the quality of medicine, I think. For me this is non-sense. Telemedicine should not become a standard of care no matter what. Doctors cannot do good medicine through a computer. A correct and complete clinical evaluation is simply not possible with telemedicine. If a doctor defends telemedicine as a standard practice, he/she must not be happy with being a doctor. This is not the way. The solution is to find green ways of traveling with acceptable costs for patients and their families. Do governments, energy enterprises, car factories, and transport companies want that to happen?
Everybody wants to protect the environment, but no one wants to lose anything. The “I” always comes first. Will this human idea of “self-protection first” be overwhelmed by the idea of “global security first” in a near future? Are we open to taking risks (lower surgery safety) to protect the environment? When we talk about green surgery, climate changes and what we all could do to fight them, one question arises in my head.
Is green surgery the answer the world needs to face climate changes? Is green surgery the first line of action to protect the Earth? I am sure every single action matter, but I think there are many other areas governments should act in, which are much more important and crucial to fighting climate changes. However, humanity's will to make the necessary changes is not much, because money does not want to.
I wrote this simple post to make us all think about climate changes and what surgery should or should not do to help fight them. Are governments and enterprises doing all they can to reduce carbon footprints? What can we do without putting patients and surgeons at risk? Are there any other options to save the planet before true green surgery? Or is this the time to compromise patients’ and surgeons’ security to protect the environment?
Humans created climate changes. Earth will stand even without humans. If we don't want the extinction of humanity to be the final solution, humans must act now where it really matters.
Link to PubMed:
Dr. Carlos Eduardo Costa Almeida
General Surgeon
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