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Operating is a cause of climate change that no one is talking about. – Researcher

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In April 2021, during a summit of climate leaders, President Biden announced his goal to drastically reduce greenhouse gas emissions in the United States by 2030.

Victor Agbafe watched the address on TV. A medical student at the University of Michigan, who is also studying law at Yale University, immediately wrote to several teachers, including a resident of Michigan’s Comprehensive Plastic Surgery. Nicholas Berlin, MD, MSc, MSc

The question that arose from their reports was crucial: what role can the medical community, which accounts for about 8.5% of America’s greenhouse gas emissions, play in these efforts to reduce climate change?


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A year later, a study conducted by Agbafe and Berlin reveals some answers. Their article describes how surgery, particularly cancer surgery, contributes to climate change, and offers some solutions to tackle the problem, from waste reduction to rethinking ways to provide surgical care.

“In general, these ideas are good for our planet,” Agbafe said. “But also, unfortunately, surgery plays a disproportionately large role in the carbon output and waste we produce in medicine.”

Operating rooms are a massive source of greenhouse gas emissions for hospitals, which account for 70% of their waste and produce three to six times more carbon than other health systems.

Berlin notes that cancer treatment is an obvious goal for a more environmentally friendly effort in surgery because it often involves intensive care for a short period of time.

In addition, minimally invasive, energy-intensive surgeries, including robotic surgeries, have become common treatments for cancers ranging from colorectal cancer and uterine cancer to head and neck cancer. For example, with the help of robots hysterectomy produces as much carbon as driving more than 2,200 miles – the equivalent of a trip from Arbor, Michigan, to Los Angeles.

“If we can reduce greenhouse gas emissions, we have a chance to extend the life expectancy of our patients and expand access to timely care,” Agbafe said. “And we believe it’s very important that the surgical community be active at this table.”

What to do differently

One of the most possible changes in this space would be waste reduction, Agbafe said.

This can be as simple as making sure that everything that was thrown away before or during the operation is properly classified and labeled, as it is estimated that more than 90% of waste OR does not meet the required standards for the type of rubbish they end up in. . (The red garbage bags in OR are only for items that have been exposed to body fluids, and are much more expensive to dispose of than transparent recycling bags.)

Hospitals may also consider switching to some reusable or recycled devices and surgical gowns, as there is no link between re-used instruments and infections purchased at the hospital.

Some other suggestions of the pair include optimizing the use of OR energy. Agbafe and Berlin draw attention to the recommendations of the American Society of Health Engineers to install energy-efficient lighting, plan preventive maintenance and minimize airflow in rooms that are not used as simple ways of environmentally friendly systems.

The surgical supply chain could also be more efficient, they write. It is estimated that 87% of surgical instruments intended for surgery are rarely used, so creating standardized lists of essential instruments for regular operations can reduce the cost, waste, and energy required to sterilize and repackage these instruments. .

Moving more production of surgical supplies closer to hospitals – or choosing suppliers locally – can also reduce carbon emissions in ABS.

“Given some of the geopolitical developments currently taking place in Ukraine and China, and the competition there along with the effects of the pandemic, there is an increasing emphasis on sustainability in supply chains,” Agbafe said. “So this idea of ​​localizing our operating supply chains is something that the public has a lot of political energy and impetus for.”

Rethinking assistance

But perhaps the broadest way the cancer space can reduce greenhouse gas emissions is to change the way surgical care is provided, starting with the constant provision of telemedicine.

“We believe that telemedicine is a great opportunity for us to reduce the impact on the climate and improve the quality of care,” said Agbafe. “During the pandemic, we used virtual care, and if we could make this a routine aspect of cancer treatment before and after surgery, it’s a way to reduce the climate impact from providing care and make it more convenient for patients ”.

Reducing low-cost care is another way to eliminate carbon-related activities associated with unnecessary scans, testing, and procedures.

This has been a priority for UM, thanks The Michigan Value Program – Cooperation between Michigan Medicine and the Institute of Health Policy of the University of Michigan, aimed at improving the quality of care in the institution – and partnerships with similar organizations Michigan Value Collaborativealso referred to as MVC, a joint quality initiative that serves the entire state.

Last year, the two organizations collaborated on a study that highlighted how many routine tests were still done before surgeries despite the low value. The first author was Berlin.

“UM is considered one of the leading institutions studying low-value aid and trying to limit this type of aid,” said Berlin. “But, like many other centers, we are really on the verge of these initiatives. I would expect big changes in the next 10 years. “

From gas to (more stable) gas

Some shifts in sustainability may occur even earlier in Michigan Medicine.

For example, the Department of Anesthesiology recently launched the Green Anesthesia Initiative, or GAIA for short. Its mission: to become more environmentally conscious regarding the types and rates of anesthesia used by its suppliers, another area, according to Agbafe and Berlin, is ripe for improvement.

“It’s a topic of quite intense discussion in this area, and I’ve been thinking about it for a while,” he said. George Mashur, Doctor of Medicine, Doctor of Philosophy, Chair of the Department of Anesthesiology and Professor of Anesthesiology Robert B. Sweet at the University of Michigan Medical School. “Unlike other industries, I don’t think we need serious failures to make progress because, thankfully, we have options.”

Several inhaled gases that are regularly used for anesthesia are offenders on list A when it comes to greenhouse gas production. Nitrous oxide, commonly known as gaseous gas, is a greenhouse gas that is a direct destroyer of ozone and does not dissipate from the atmosphere for more than a century after its production.

However, the inhaled anesthetic sevaflurane has a much smaller impact on the environment than nitrous oxide and other conventional inhaled agents, so Mashur says it would be a good alternative.

“The overall goal is to get away from some of these outrageous culprits and start better choosing which drug we use and then also how we use it,” Mashur said.

“The contribution in terms of the effect of greenhouse gases or ozone-depleting effects is partly related to how much is pumped into the atmosphere, and this is directly related to how high our flow of fresh gas is,” he added. “If we have, say, 10 liters, we blow a lot of anesthetic into the cleaning and waste systems and atmospheric systems that shouldn’t be there.”

To this end, Mashur’s colleagues from the Department of Anesthesiology are already leading a national initiative to reduce the flow rate of anesthetic gas through A multicenter group of perioperative outcomesanother quality initiative that includes health centers from across the country.

Mashur plans to deploy other elements of GAIA over a three- to five-year period.

“We could have done better,” he said. “Right now we’re starting conversations, engaging people and making structural choices in the department to help people do the right thing.”

IMAGE Credit: Jacob Dwyer / Michigan Medicine