Department of Clinical Sciences Lund, Anesthesiology and Intensive Care, Lund University, Lund, Sweden.
Centre for Environmental and Climate Science, Faculty of Science, Lund University, Lund, Sweden.
PLoS One. 2022 Jul 15;17(7):e0271601. doi: 10.1371/journal.pone.0271601. eCollection 2022.
Climate change is one of the 21st century's biggest public health issues and health care contributes up to 10% of the emissions of greenhouse gases in developed countries. About 15 million laparoscopic procedures are performed annually worldwide and single-use medical equipment is increasingly used during these procedures. Little is known about costs and environmental footprint of this change in practice.
We employed Life Cycle Assessment method to evaluate and compare the environmental impacts of single-use, reusable, and mixed trocar systems used for laparoscopic cholecystectomies at three hospitals in southern Sweden. The environmental impacts were calculated using the IMPACT 2002+ method and a functional unit of 500 procedures. Monte Carlo simulations were used to estimate differences between trocar systems. Data are presented as medians and 2.5th to 97.5th percentiles. Financial costs were calculated using Life Cycle Costing.
The single-use system had a 182% higher impact on resources than the reusable system [difference: 5160 MJ primary (4400-5770)]. The single-use system had a 379% higher impact on climate change than the reusable system [difference: 446 kg CO2eq (413-483)]. The single-use system had an 83% higher impact than the reusable system on ecosystem quality [difference: 79 PDFm2yr (24-112)] and a 240% higher impact on human health [difference: 2.4x10-4 DALY/person/yr (2.2x10-4-2.6x10-4)]. The mixed and single-use systems had a similar environmental impact. Differences between single-use and reusable trocars with regard to resource use and ecosystem quality were found to be sensitive to lower filling of machines in the sterilization process. For ecosystem quality the difference between the two were further sensitive to a 50% decrease in number of reuses, and to using a fossil fuel intensive electricity mix. Differences regarding effects on climate change and human health were robust in the sensitivity analyses. The reusable and mixed trocar systems were approximately half as expensive as the single-use systems (17360 € and 18560 € versus 37600 €, respectively).
In the Swedish healthcare system the reusable trocar system offers a robust opportunity to reduce both the environmental impact and financial costs for laparoscopic surgery.
气候变化是 21 世纪最大的公共卫生问题之一，医疗保健行业的温室气体排放量占发达国家总排放量的 10%左右。全球每年约有 1500 万例腹腔镜手术，在此过程中越来越多地使用一次性医疗器械。但对于这种实践中的变化所带来的成本和环境影响，人们知之甚少。
我们采用生命周期评估方法，在瑞典南部的三家医院评估和比较了用于腹腔镜胆囊切除术的一次性、可重复使用和混合套管系统的环境影响。使用 IMPACT 2002+方法和 500 例手术的功能单位计算环境影响。使用蒙特卡罗模拟来估计套管系统之间的差异。数据以中位数和第 2.5 至第 97.5 百分位数表示。使用生命周期成本法计算财务成本。
与可重复使用系统相比，一次性系统对资源的影响高出 182%[差异：5160 MJ 初级（4400-5770）]。与可重复使用系统相比，一次性系统对气候变化的影响高出 379%[差异：446 千克 CO2eq（413-483）]。与可重复使用系统相比，一次性系统对生态系统质量的影响高出 83%[差异：79 PDFm2yr（24-112）]，对人类健康的影响高出 240%[差异：2.4x10-4 DALY/人/年（2.2x10-4-2.6x10-4）]。混合和一次性系统具有相似的环境影响。在资源利用和生态系统质量方面，一次性和可重复使用套管之间的差异对机器在消毒过程中的填充量较低很敏感。对于生态系统质量，两者之间的差异进一步取决于重复使用次数减少 50%，以及使用化石燃料密集型电力组合。关于气候变化和人类健康影响的差异在敏感性分析中是稳健的。可重复使用和混合套管系统的成本约为一次性系统的一半（分别为 17360 欧元、18560 欧元和 37600 欧元）。
在瑞典医疗保健系统中，可重复使用的套管系统为减少腹腔镜手术的环境影响和财务成本提供了一个稳健的机会。
