Youth activism for health: taking the future into their own handsBMJ 2019; 367 doi: https://doi.org/10.1136/bmj.l6881 (Published 17 December 2019) Cite this as: BMJ 2019;367:l6881
All rapid responses
This year has seen unprecedented focus on our climate change emergency (1). Juliet Dobson's Christmas article cites Greta Thunberg and her peers calling for adults to join them campaigning for global climate activism “To change everything, we need everyone" (2)
Therefore with the new year approaching, we recommend some self-awareness on usage of equipment in surgical theatres to inform our upcoming resolutions.
In the UK, some estimates find the National Health Service (NHS) responsible for 25% of public sector emissions (3).
Grant and Bailey explained how we can calculate the whole hospital footprint and advocate for change (4). Although much has been written about volatile anaesthetic agents contributing to greenhouse gas emissions, there has been less attention paid to surgical equipment itself. Mac’Neill et al (5) wrote a comprehensive analysis of the total carbon footprint of surgery and found anaesthetic gases and energy consumption for heating and ventilation were the largest sources of greenhouse gas emissions. However, they also found variation in surgical consumables and textiles disposal: with some hospitals considering all surgical gowns and drapes as hazardous waste, even if not heavily soiled with bodily fluids, and therefore
incurring higher emissions from incineration. Morris et al (6) were the first to examine specialty level carbon emissions, and quantified the carbon footprint of a cataract procedure performed in one hospital in Cardiff to be 405.4 tonnes CO2eq over the course of a year.
In the UK, an estimated 57,000 tonsillectomies occur each year (7), making this one of the most commonly performed elective surgical procedures. In our hospital alone, we performed 1,067 adenotonsillar procedures last year. The surgical consumables from a tonsillectomy or adenotonsillectomy are divided into orange and black bags depending on incineration or landfill. As the wider operating theatre waste is entered into the black bags, we chose to weigh the orange bag waste which was directly attributable to the ENT surgeon. The range of orange bag waste weight produced was 1.07 kg to 2.30 kg at a mean of 1.86 kg across 10 procedures. If this waste weight was consistent throughout the entire year this would lead to 1,984 kg of incinerated waste produced by surgeons from adenotonsillar procedures per year in our hospital alone. Extrapolated to the whole country, this would be 106,020 kilograms of incinerated waste per year (106 tonnes).
In light of our current climate crisis, we should go further than switching to reusable coffee cups. We need everyone and we hope this letter prompts surgeons and theatre staff to think, act and advocate for the change they wish to see.
1. Nature 573, 311 (2019) doi: 10.1038/d41586-019-02735-w
2. BMJ 2019;367:l6881
3. NHS Sustainable Development Unit (2008, updated 2009, 2016). NHS England carbon emissions carbon footprinting report. http://www.sdu.nhs.uk/documents/publications/1263313924_jgyW_nhs_england...
4. Grant Paul, Bailey Sarah Lou. Calculate the carbon footprint of your hospital BMJ 2010; 341:c2366
6. Morris, D., Wright, T., Somner, J. et al. The carbon footprint of cataract surgery. Eye 27, 495–501 (2013) doi:10.1038/eye.2013.9
8. UK Without Incineration Network: Evaluation of the climate change impacts of waste
incineration in the United Kingdom (Oct 2018) http://ukwin.org.uk/files/pdf/UKWIN-2018-
Competing interests: No competing interests