A fresh study out of the UK has found a reliance on single-use cataract surgery items created a carbon footprint 27 times greater than reusable equivalents.
The collaboration between University Hospital of Wales and Oxford’s Centre for Sustainable Healthcare, published the Royal College of Ophthalmologists’ official peer-reviewed journal Eye, set out to analyse the environmental impact of disposable surgical waste in cataract surgery – the most commonly performed hospital procedure.
They noted theatre activity overall is a major source of hospital waste, accounting for 21–30% of total output, and is three to six times more energy-intensive than any other hospital department.
The study evaluated the carbon impact in two ways: by “streamlining” the use of single-use packs, and transitioning from single-use items to reusable equivalents in cataract surgery.
To achieve this, a focus group and prospective audit was carried out to identify single-use pack items for streamlining.
A “bottom-up, process-based carbon footprint analysis” was conducted of single-use items and reusable alternatives, using activity data by the suppliers and greenhouse gas (GHG) conversion factors from the UK Government GHG Conversion Factors for Company Reporting database.
They found that by streamlining the use of single-use packs they were able to achieve a carbon saving of 935 kgCO2e/year. Meanwhile, switching to reusables created a 309 kgCO2e/year saving.
But a net carbon saving was achieved from 19 or more re-uses of the reusable items compared to single-use equivalents.
Tellingly, they found “single-use items had a 27 times greater carbon footprint than reusable equivalents (322 kgCO2 vs. 12 kgCO2e respectively)”.
They said the study provided evidence of carbon emissions savings both from streamlining disposable instruments in cataract surgical packs, and from switching to reusable instruments.
“Mitigation strategies targeting hotspots in resource intensive areas will be an important aspect of reducing the climate burden of surgery,” they concluded.
“Change in practice and policy is required in all surgical specialities to realise net zero carbon healthcare.”
What’s happening in Australia?
In 2022, Insight published a deep dive into the efforts to minimise cataract surgery waste,
In that article, Dr Jesse Gale, who was appointed inaugural chair of RANZCO’s Sustainability Committee, rued the use of single-use items.
“Our greatest source of emissions is procurement and the consumption of single-use supplies, and excessive packaging,” he said at the time.
He added that some of his colleagues on RANZCO’s Sustainability Committee were disappointed to discover some ophthalmologists were using large and expensive single-use drapes to cover the patient’s whole body, for cataract surgery.
“We only need the drape to cover the face to prevent contamination of the field. We hope surgeons would consider using the smallest, lightest drape, or even a re-usable drape,” he said.
“Another waste-saving idea is to use a topical anaesthetic instead of injecting, to avoid using extra syringes and discarded pharmaceuticals.”
He has since turned his attention to measuring the carbon footprint of intravitreal injections.
More reading
Performing cataract surgery … sustainably
Major Aussie study: Surgeons in public sector seeing more complex cataract cases
Study: Patients less anxious in immediate bilateral cataract surgery
