Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries. Results: In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion: This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries.
Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries
Adisa, Adewale; Bahrami-Hessari, Michael; Bhangu, Aneel; George, Christina; Ghosh, Dhruv; Glasbey, James; Haque, Parvez; Ingabire, J C Allen; Kamarajah, Sivesh Kathir; Kudrna, Laura; Ledda, Virginia; Li, Elizabeth; Lillywhite, Robert; Mittal, Rohin; Nepogodiev, Dmitri; Ntirenganya, Faustin; Picciochi, Maria; Simões, Joana Filipa Ferreira; Booth, L; Elliot, R; Kennerton, A S; Pettigrove, K L; Pinney, L; Richard, H; Tottman, R; Wheatstone, P; Wolfenden, John W D; Smith, A; Sayed, A Emad; Goswami, Aakansha Giri; Malik, Aamer; Mclean, Aaron Lawson; Hassan, Abbas; Nazimi, Abd Jabar; Aladna, Abdallah; Abdelgawad, Abdalrahman; Saed, Abdel; Abdelmageed, Abdelfatah; Ghannam, Abdelilah; Mahmoud, Abdelrahman; Alvi, Abdul; Ismail, Abdulaziz; Adesunkanmi, Abdulhafiz; Ebrahim, Abdulla; Al-Mallah, Abdullah; Alqallaf, Abdullah; Durrani, Abdullah; Gabr, Abdullah; Kirfi, Abdullahi Musa; Altaf, Abdulmalik; Almutairi, Abdulmjeed; Sabbagh, Abdulrahman J; Ajiya, Abdulrazak; Haddud, Abdurrahman; Alnsour, Abed Alfattah Mahmoud; Singh, Abhinav; Mittal, Abhishek; Semple, Abigail; Adeniran, Abiodun; Negussie, Abraham; Oladimeji, Abraham; Muhammad, Abubakar Bala; Yassin, Abubaker; Gungor, Abuzer; Tarsitano, Achille; Soibiharry, Adaiah; Dyas, Adam; Frankel, Adam; Peckham-Cooper, Adam; Truss, Adam; Issaka, Adamu; Ads, Adel Mohamed; Aderogba, Adeleke Akeem; Adeyeye, Ademola; Ademuyiwa, Adesoji; Sleem, Adham; Papa, Adrian; Cordova, AdrianaMembro del Collaboration Group ; Appiah-Kubi, Adu; Meead, Adullah; Nacion, Aeris Jane D; Michael, Afieharo; Forneris, Agustin Albani; Duro, Agustin; Gonzalez, Agustin Rodriguez; Altouny, Ahmad; Ghazal, Ahmad; Khalifa, Ahmad; Ozair, Ahmad; Quzli, Ahmad; Haddad, Ahmad; Othman, Ahmad Faidzal; Yahaya, Ahmad Shuib; Elsherbiny, Ahmed; Nazer, Ahmed; Tarek, Ahmed; Abu-Zaid, Ahmed; Al-Nusairi, Ahmed; Azab, Ahmed; Elagili, Ahmed; Elkazaz, Ahmed; Kedwany, Ahmed; Nuhu, Ahmed Mohammed; Sakr, Ahmed; Shehta, Ahmed; Shirazi, Ahmed; Mohamed, Ahmed Mohamed Ibrahim; Sherif, Ahmed Elshawadfy; Awad, Ahmed K; Abbas, Ahmed M; Abdelrahman, Ahmed Saber; Ammar, Ahmed Siddique; Azzam, Ahmed Y; Ciftci, Ahmet Burak; Dural, Ahmet Cem; Sanli, Ahmet Necati; Rahy-Martín, Aida Cristina; Tantri, Aida Rosita; Khan, Aimal; Al-Touny, Aiman; Tariq, Aiman; Gmati, Aimen; Costas-Chavarri, Ainhoa; Auerkari, Aino; Landaluce-Olavarria, Aitor; Puri, Ajay; Radhakrishnan, Ajay; Ubom, Akaninyene Eseme; Pradhan, Akhilesh; Turna, Akif; Adepiti, Akinfolarin; Kuriyama, Akira; Kassam, Al-Faraaz; Hassouneh, Ala; El-Hussuna, Alaa; Habeebullah, Alaa; Ads, Alaa Mohamed; Mousli, Alaa; Biloslavo, AlanMembro del Collaboration Group ; Hoang, Alan; Kirk, Alan; Santini, Alasdair; Melero, Alba Vazquez; Calvache, Albaro José Nieto; Baduell, Albert; Chan, Albert; Abrate, Alberto; Balduzzi, Alberto Membro del Collaboration Group ;Sánchez, Alberto Cabañero; Navarrete-Peón, Alberto; Porcu, Alberto; Brolese, Alberto; Barranquero, Alberto G; Saibene, Alberto Maria; Adam, Albushra Altayeb; Vagge, Aldo; Maquilón, Alejandra Jara; Leon-Andrino, Alejandro; Sekulić, Aleksandar; Trifunovski, Aleksandar; Mako, Aleksandro; Bedada, Alemayehu Ginbo; Broglia, Alessandro; Coppola, Alessandro; Giani, Alessandro; Grandi, Alessandro; Iacomino, Alessandro; Moro, Alessandro; D’amico, Alessia; Malagnino, Alessia; Tang, Alethea; Doyle, Alex; Alfieri, Alex; Haynes, Alex; Wilkins, Alex; Baldwin, Alexander; Heriot, Alexander; Laird, Alexander; Lazarides, Alexander; O'connor, Alexander; Trulson, Alexander; Rokohl, Alexander Christopher; Caziuc, Alexandra; Triantafyllou, Alexandra; Anesi, Alexandre; Nikova, Alexandrina; Andrianakis, Alexandros; Charalabopoulos, Alexandros; Tsolakidis, Alexandros; Chirca, Alexandru; Arnaud, Alexis P; Narvaez-Rojas, Alexis Rafael; Kavalakat, Alfie; Spina, Alfio; Recordare, Alfonso; Annicchiarico, Alfredo; Conti, Alfredo; Mohammed, Alhassan Datti; Kocataş, Ali; Almhimid, Ali; Arnaout, Ali; Fahmy, Ali; Mangi, Ali; Modabber, Ali; Ulas, Ali Bilal; Mohamedahmed, Ali Yasen Y; Frontali, Alice; Moynihan, Alice; Yunus, Alif; Ahmad, Aline; Kent, Alistair J; Khamees, Almu'atasim; Ugwu, Aloy Okechukwu; Turan, Alparslan; Mohammed, Alsnosy Abdullah Khalefa; Navarro-Barrios, Alvaro; Yebes, Alvaro; De Sousa, Álvaro Francisco Lopes; Moreno, Amabelle; Sethi, Aman; Dawson, Amanda Caroline; Othman, Amani Alsayd Abdulsalam; Kaur, Amanjot; Wolde, Amanuel; Antonelli, Amedeo; Scifo, Amedeo; Alhamad, Ameen; Davis, Amelia; Alderazi, Amer; Harky, Amer; Mohammed-Durosinlorun, Amina; Seguya, Amina; Okhakhu, Amina; Chamakhi, Amine; Sebai, Amine; Souadka, Amine; Asla, Amir; Agrawal, Amit; Persad, Amit; Gupta, Amit; Elgazar, Amr; Kulkarni, Amruta; Coates, Amy; Bellés, Ana Ciscar; Hadzibegovic, Ana Danic; Jotic, Ana; Kowark, Ana; Martins, Ana; Pineda, Ana Mejía; Peral, Ana; Gollarte, Ana Sánchez; Senent-Boza, Ana; Camarena, Ana Isabel Avellaneda; Castaño-Leon, Ana M; Bravo, Ana Maria Minaya; Moro, Ana María Gimeno; Musina, Ana-Maria; Tapia-Herrero, Ana-María; Kothari, Anai; Gupta, Anand; Raja, Anand; Aljaiuossi, Anas; Taha, Anas; Majbar, Anass Mohammed; 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Quintana-Villamandos, Begoña; Girgin, Behiç; Barmayehvar, Behrad; Beisenov, Bekzat; Creavin, Ben; Dunne, Ben; Marson, Ben; Waterson, Ben; Martin, Benjamin; Zucker, Benjamin; Wong, Benjamin Ngie Xiong; Ozmen, Berk Baris; Hammond, Bernard; Mbwele, Bernard; Núñez, Bernardo; Dhondt, Bert; Gafsi, Besma; Mcleish, Bethan; Lieske, Bettina; Tailor, Bhavesh; La Pira, Biagia; Picardi, Biagio; Zampogna, Biagio; Casagranda, BiagioMembro del Collaboration Group ; Festa, Bianca Maria; Panda, Bijnya; Kirmani, Bilal; Sulaiman, Bilal; Gurung, Binay; Zacharia, Bincy; Bette, Birgit; Ayana, Birhanu; Nikolovska, Bisera; Vilaró, Blanca Capdevila; De Vega Sánchez, Blanca; Hameed, Bm Zeeshan; Diaconescu, Bogdan; Kovacevic, Bojan; Bumber, Boris; Sakakushev, Boris; Tadic, Boris; Malek, Bouhani; Alrayes, Bourhan; Thomas, Bradley; Gális, Branislav; Gallagher, Brendan; Knowles, Brett; Cunningham, Brian; Daley, Brian; Mishra, Brijesh; Ashford, Bruce; Pirozzi, Brunella Maria; Berselli, Bruno; Martinez-Leo, Bruno; Sensi, Bruno; Nardo, Bruno; Celik, Burak; Giray, Burak; Abud, Burçin; Almiqlash, Bushray; Pramesh, C S; Taskiran, Cagatay; De Campos Prado, Caio Antonio; Cipolla, Calogero; Kumar, Calvin; English, Camilla; Riccetti, Camilla; Vanni, Camilla; Brasset, Camille; Downey, Candice; Duffy, Caoimhe; Chwat, Carina; Cutmore, Carina; Sars, Carl; Ratto, Carlo; Pacilio, Carlo Alberto; De La Infiesta García, Carlos; Moreno, Carlos Guijarro; Magalhães, Carlos; Prada, Carlos; Zapata, Carlos Shiraishi; Senni, Carlotta; Flumignan, Carolina Dutra Queiroz; Martinez-Perez, Carolina; Duarte, Carolina Lugo; Garcia, Carolina Soledad Romero; Anderson, Caroline; Hing, Caroline; Cullinane, Carolyn; Cina, Caterina; Zabkiewicz, Catheriner; Sohrabi, Catrin; Guldogan, Cem Emir; Ciubotaru, Cezar; Desai, Chaitya; Raut, Chandrajit; Demetriou, Charis; Handford, Charles; Okpani, Charles; Paranjape, Charudutt; Koh, Cherry; Khatri, Chetan; Parmar, Chetan; Mok, Chi Wei; Caricato, Chiara; Marafante, Chiara; Echieh, Chidiebere Peter; Tan, Chih Ying; Ong, Chon Sum; Conso, Christel; Jardinez, Christiaan; Konrads, Christian; Warner, Christian; Makwe, Christian Chigozie; Henein, Christin; Fleming, Christina; Roland, Christina L; Maurus, Christine; Nitschke, Christine; Mittermair, Christof; Mallmann, Christoph; Andro, Christophe; Harmston, Christopher; Kuppler, Christopher; Lotz, Christopher; Nahm, Christopher; Rowe, Christopher; Ryalino, Christopher; Wallis, Christopher; Millward, Christopher Paul; Anthoulakis, Christos; Apostolou, Christos; Chouliaras, Christos; Kalfountzos, Christos; Kaselas, Christos; Vosinakis, Christos; Okereke, Chukwuma; Chean, Chung Shen; Barlow, Ciaran; Tatar, Cihad; Clancy, Cillian; Forde, Cillian; Sharpin, Claire; Mccarthy, Claire; Nestor, Claire; Warden, Claire; Ávila, Clara Castro; Massaguer, Clara; Fang, Clarissa Ern Hui; Martins, Claudia Pinto; Guerci, Claudio; Mauriello, Claudio; Holzmeister, Clemens; Miller, Clemens; Weber, Clemens; Wiesinger, Clemens Georg; Kenington, Cleo; Noel, Colin; Sue-Chue-Lam, Colin; Adumah, Collins; Neary, Colm; Sen, Comert; Fitzgerald, Conall; Ezeme, Constantine; Nastos, Constantinos; Mesina, Cristian; Bombardini, Cristina; Torregrosa, Cristina; Valdespino, Cristina Puentes; Don, Cristine Pathirannehalage; Wickramasinghe, Dakshitha; Milanesi, Damiano; Armijos, Daniel; Asiimwe, Daniel; Beswick, Daniel; Clerc, Daniel; Cox, Daniel; Doherty, Daniel; Martínez, Daniel Fernández; Lechuga, Daniel Garay; Gero, Daniel; Gil-Sala, Daniel; Lindegger, Daniel; Reim, Daniel; Shaerf, Daniel; Shmukler, Daniel; Branzan, Daniela; Filipescu, Daniela; Rega, Daniela; Bernardi, Daniele; Bissacco, Daniele; Fusario, Daniele; Morezzi, Daniele; Sabella, Danielle; Zimak, Danijela Mrazovac; Vinci, Danilo; Sale, Danjuma; Khan, Danyal Zaman; Thereska, Dariel; Andreotti, Dario; Tartaglia, Dario; Abdulai, Darling Ramatu; Mukherjee, Dattatreya; Verdi, Daunia; Idowu, David; John, David; Johnson, David; Moro-Valdezate, David; Naumann, David; Omar, David; Proud, David; Roberts, David; Guzmán, David Santos; 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Poillucci, Gaetano; Thiruchandran, Gajendiran; Nicholson, Gary; Groot, Gary; Hoey, Gary; Bass, Gary Alan; Sachdev, Gaurav; Agarwal, Gaurav; Aggarwal, Gaurav; Cormio, Gennaro; Mazzarella, Gennaro; Perrone, Gennaro; Osterhoff, Georg; Singer, Georg; Dejeu, George; Fowler, George; Garas, George; Gradinariu, George; Theodoropoulos, George; Tzimas, George; Babis, George; Wong, George Kwok Chu; Cross, George W V; Micha, Georgia; Chrysovitsiotis, Georgios; Koukoulis, Georgios; Peros, Georgios; Tsoulfas, Georgios; Kapetanios, Georgios; Karagiannidis, Georgios; Verras, Georgios-Ioannis; Ekwen, Gerald; Perrotta, Gerardo; Petruzzi, Gerardo; Bertelli, Giacomo;