Phull Manraj, Begum Hasina, John Joseph B, van Hove Maria, McGrath John, O'Flynn Kieran, Briggs Tim W R, Gray William K
Urology Department, West Hertfordshire Hospitals NHS Trust, Watford, UK.
Greener NHS National Programme, NHS England, London, UK.
Eur Urol Open Sci. 2023 Apr 30;52:44-50. doi: 10.1016/j.euros.2023.03.007. eCollection 2023 Jun.
The National Health Service (NHS) in England has set a net-zero target for carbon emissions by 2040. Increasing use of day-case surgery pathways may help in meeting this target.
To investigate the estimated difference in carbon footprint between day-case and inpatient transurethral resection of bladder tumour (TURBT) surgery in England.
This was a retrospective analysis of administrative data extracted from the Hospital Episode Statistics database for all TURBT procedures conducted in England from April 1, 2013 to March 31, 2022.
Day-case and inpatient TURBT procedures were identified and the carbon footprint for key elements of the surgical pathway was estimated using data from Greener NHS and the Sustainable Healthcare Coalition.
Of 209 269 TURBT procedures identified, 41 583 (20%) were classified as day-case surgery. The day-case rate increased from 13% in 2013-2014 to 31% in 2021-2022. The move from inpatient stays to day-case surgery between 2013-2014 and 2021-2022 demonstrates a trend toward a lower-carbon pathway, with an estimated saving of 2.9 million kg CO equivalents (equivalent to powering 2716 homes for 1 yr) in comparison to no change in practice. We calculated that potential carbon savings for the financial year 2021-2022 would be 217 599 kg CO equivalents (equivalent to powering 198 homes for 1 yr) if all hospitals in England not already in the upper quartile were able to achieve the current upper-quartile day-case rate. Our study is limited in that estimates are based on carbon factors for generic surgical pathways.
Our study highlights potential NHS carbon savings that could be achieved by moving from inpatient stays to day-case surgery. Reducing variation in care across the NHS and encouraging all hospitals to adopt day-case surgeries, where clinically appropriate, would lead to further carbon savings.
In this study we estimated the potential for carbon savings if patient undergoing bladder tumour surgery were admitted and discharged on the same day. We estimate that increasing use of day-case surgery between 2013-2014 and 2021-2022 has saved 2.9 million kg CO equivalents. If all hospitals were to achieve day case-rates comparable to those in the highest quarter of hospitals in England in 2021-2022, then the carbon equivalent to powering 198 homes for 1 year could have been saved.
英国国家医疗服务体系（NHS）设定了到2040年实现碳排放净零的目标。增加日间手术路径的使用可能有助于实现这一目标。
调查英格兰日间手术与住院膀胱肿瘤经尿道切除术（TURBT）手术之间估计的碳足迹差异。
设计、设置和参与者：这是一项对从医院事件统计数据库中提取的行政数据进行的回顾性分析，该数据库涵盖了2013年4月1日至2022年3月31日在英格兰进行的所有TURBT手术。
识别出日间手术和住院TURBT手术，并使用来自更绿色NHS和可持续医疗联盟的数据估计手术路径关键要素的碳足迹。
在识别出的209269例TURBT手术中，41583例（20%）被归类为日间手术。日间手术率从2013 - 2014年的13%上升至2021 - 2022年的31%。2013 - 2014年至2021 - 2022年期间从住院治疗转变为日间手术表明了向低碳路径的趋势，与实践无变化相比，估计节省了290万千克二氧化碳当量（相当于为2716户家庭供电1年）。我们计算得出，如果英格兰所有尚未达到上四分位数的医院能够实现当前的上四分位数日间手术率，那么2021 - 2022财政年度潜在的碳节省量将为217599千克二氧化碳当量（相当于为198户家庭供电1年）。我们的研究存在局限性，即估计基于通用手术路径的碳因子。
我们的研究突出了通过从住院治疗转变为日间手术可实现的NHS潜在碳节省。减少整个NHS护理的差异，并鼓励所有医院在临床合适的情况下采用日间手术，将进一步节省碳。
在本研究中，我们估计了膀胱肿瘤手术患者当日入院和出院时的碳节省潜力。我们估计，2013 - 2014年至2021 - 2022年期间日间手术使用的增加节省了290万千克二氧化碳当量。如果所有医院都能实现与2021 - 2022年英格兰医院最高四分位数相当的日间手术率，那么相当于为198户家庭供电1年的碳量本可节省下来。
