Implementing Green Surgery: Key to Decreasing Global Healthcare Carbon Footprint

As the world hurtles towards a seemingly unstoppable climate crisis, the search has intensified for ways of reducing the amounts of planet-warming carbon dioxide that humanity pumps into the atmosphere.

The healthcare sector is major emitter of carbon – if the global sector were a country, it would be the world’s fifth largest polluter. The UK’s National Health Service (NHS) contributes six per cent of the country’s total carbon footprint – operating theatres make up as much as 25% of hospitals’ contribution, but 3 in every 4 people need surgery in their lives.

There is a great opportunity here to begin making inroads into the sector’s carbon footprint. Led by the University of Birmingham, the NIHR Global Health Research Unit on Global Surgery is taking the first steps along the road to sustainable healthcare.

Surgeons and academics from around the world gathered on our Birmingham campus in late 2023 to consider research to achieve net zero emissions in operating theatres. The Research for Greener Surgery Conference 2023 saw experts considering how healthcare providers can decarbonise surgery while maintaining the highest standards of patient care.

This ground-breaking event built on earlier research success in this field, including the first documented ‘net zero’ operation in the NHS – patient discharged safely and recovering well from a keyhole procedure to remove a bowel cancer.

Performed at Solihull Hospital in 2022, this operation saw University of Birmingham experts working with a surgical team at University Hospitals Birmingham NHS Foundation Trust to complete the operation. The operation introduced several changes to normal practice such as: using reusable gowns, drapes, and scrub caps; minimising electricity use; and giving medications through the veins for general anaesthesia rather than using anaesthetic gases, which have a strong greenhouse effect

The hospital team worked with experts at the University of Birmingham to prepare for the operation – using a process combining evidence-based approaches and a carbon output calculator developed specifically for this task. Part of a Green Surgery toolkit, the calculator forms part of a frontline set of interventions that will set the carbon-reduction wheels in motion.

Successfully completing the ‘net-zero’ surgery formed a key staging point on the road to bringing experts together at December’s conference. Professor Lucy Chappell, Chief Executive Officer of the National Institute for Health and Care Research and Chief Scientific Advisor for the Department of Health and Social Care, launched the conference – setting out the importance of taking an evidence-based approach to net zero surgery and the challenges associated with achieving this goal.

The conference highlighted the importance of health and care research working together with capacity building to respond to the global challenge of working towards net zero. The Global Surgery Unit is being supported with an NIHR Green Surgery grant, which is funding the team to deliver a range of interventions in the NHS.

Climate change is intricately linked with human health. We can only achieve our sustainability goals by working with colleagues across the UK to create a wider impact across the whole NHS. Our conference provided a major step forward in greening surgery across the UK and making the NHS a global example of what can be done for environmentally sustainable healthcare.

The gathering in Birmingham looked at how we can use research to reducing carbon footprint across the health and care system, whilst analysing how research delivery assists the delivery of more patient-centred, lower carbon healthcare.

We must create elective surgery hubs to boost surgical capacity, alongside changing behaviours in theatre to reduce waste and a joint health-education solar strategy to decarbonise energy whilst wrapping in local GP practices, schools.

The NHS aims to be net carbon zero by 2040, but we can’t achieve this without making surgery greener. Environmentally friendly healthcare is important to patients and communities but requires changes in behaviour and care pathways across complex teams.

Operating theatres are critical to preventing life-limiting disease but represent a hospital’s biggest source of carbon and waste. We can help to remedy this conundrum through sustainable surgery, defined through the delivery of three key themes:

• Capacity – sufficient staff and space to increase the volume of surgical care in the safest way possible
• Training – using digital innovations to upskill the next generation, enabling them to make the best decisions for patients
• Environmental Sustainability – the next frontier

We must create elective surgery hubs to boost surgical capacity, alongside changing behaviours in theatre to reduce waste and a joint health-education solar strategy to decarbonise energy whilst wrapping in local GP practices, schools.

The NHS aims to be net carbon zero by 2040, but we can’t achieve this without making surgery greener. Environmentally friendly healthcare is important to patients and communities but requires changes in behaviour and care pathways across complex teams.