Koris Jacob, Ojelade Elizabeth, Begum Hasina, Van-Hove Maria, Briggs Tim W R, Gray William K
Getting It Right First Time programme, NHS England, Wellington House, 133-135 Waterloo Road, London, SE1 8UG, UK.
NHS EI, London, UK.
Appl Health Econ Health Policy. 2025 Jan;23(1):85-92. doi: 10.1007/s40258-024-00916-x. Epub 2024 Sep 25.
The National Health Service (NHS) in England has set a target to be net zero for carbon emissions by 2045. The aim of this study was to investigate how changes in key aspects of clinical practice over the last 8 years have contributed towards reducing the per-patient carbon footprint of elective total hip arthroplasty (THA).
This was a retrospective analysis of administrative data. Data were extracted from the Hospital Episode Statistics database for all adult (≥ 17 years), primary, elective THA procedures conducted in England from 1 April, 2014 to 31 March, 2022. The estimated carbon footprint for key elements of the surgical pathway were calculated based on data from Greener NHS and the Sustainable Healthcare Coalition.
Data were available for 537,441 THA procedures conducted during the study period. The per-patient carbon footprint associated with the primary THA (index) procedure fell by around 25% from 2014/15 to 2021/22. Length of stay was by far the largest contributor to this decline, falling from 169.1 kgCOe to 117.6 kgCOe per patient from 2014/15 to 2021/22. Absolute declines in the carbon footprint associated with emergency readmissions, revisions and outpatient attendances were more modest. If all patients in all years had the 2021/22 average carbon footprint, then carbon equivalent to powering 19,976 UK homes for 1 year would have been saved.
Improving per-patient efficiency of surgery is likely to contribute towards meeting the NHS's net-zero target whilst also helping to improve patient outcomes, reduce costs and cut waiting lists.
英国国家医疗服务体系（NHS）设定了到2045年实现碳排放净零的目标。本研究的目的是调查过去8年临床实践关键方面的变化如何有助于降低择期全髋关节置换术（THA）的患者人均碳足迹。
这是一项对行政数据的回顾性分析。数据从医院事件统计数据库中提取，涵盖2014年4月1日至2022年3月31日在英格兰进行的所有成人（≥17岁）原发性择期THA手术。手术路径关键要素的估计碳足迹根据“更绿色的NHS”和可持续医疗联盟的数据计算得出。
研究期间共进行了537,441例THA手术，相关数据可得。从2014/15年度到2021/22年度，原发性THA（索引）手术的患者人均碳足迹下降了约25%。住院时间是这一下降的最大贡献因素，从2014/15年度的每位患者169.1千克二氧化碳当量降至2021/22年度的117.6千克二氧化碳当量。与急诊再次入院、翻修手术和门诊就诊相关的碳足迹的绝对下降幅度较小。如果所有年份的所有患者都具有2021/22年度的平均碳足迹，那么相当于为19,976户英国家庭供电1年的碳排放量将得以节省。
提高手术的患者人均效率可能有助于实现NHS的净零目标，同时也有助于改善患者预后、降低成本并减少候诊名单。
