Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, UK.
Welsh Centre for Burns and Plastic Surgery, Morriston Hospital, Swansea, UK.
BJS Open. 2024 Sep 3;8(5). doi: 10.1093/bjsopen/zrae084.
Climate change poses a significant global health threat and healthcare, including surgery, contributes to greenhouse gas emissions. Efforts have been made to promote sustainability in surgery, but the literature on sustainability in plastic surgery remains limited.
A life-cycle analysis was used to assess and quantify the environmental emissions associated with three distinct reconstructive methods utilized in non-melanoma skin cancer surgery: direct closure, split-thickness skin graft, and full-thickness skin graft. Analyses were conducted in March 2023 in Morriston Hospital, Swansea, UK. The carbon footprints for non-melanoma skin cancer surgery in England and Wales were then estimated.
The mean carbon emissions for non-melanoma skin cancer surgery ranged from 29.82 to 34.31 kgCO₂eq. Theatre energy consumption (4.29-8.76 kgCO₂eq) and consumables (16.87 kgCO₂eq) were significant contributors. Waste produced during non-melanoma skin cancer surgery accounted for 1.31 kgCO₂eq and sterilization of reusable surgical instruments resulted in 1.92 kgCO₂eq of carbon emissions. Meanwhile, transportation, dressings, pharmaceuticals, and laundry accounted for 0.57, 2.65, 1.85, and 0.38 kgCO₂eq respectively. The excision of non-melanoma skin cancer with direct closure (19.29-22.41 kgCO₂eq) resulted in the lowest carbon emissions compared with excision with split-thickness skin graft (43.80-49.06 kgCO₂eq) and full-thickness skin graft (31.58-37.02 kgCO₂eq). In 2021, it was estimated that non-melanoma skin cancer surgery had an annual carbon footprint of 306 775 kgCO₂eq in Wales and 4 402 650 kgCO₂eq in England. It was possible to predict that, by 2035, carbon emissions from non-melanoma skin cancer surgery will account for 388 927 kgCO₂eq in Wales and 5 419 770 kgCO₂eq in England.
This study highlights the environmental impact of non-melanoma skin cancer in plastic surgery departments and emphasizes the need for sustainable practices. Collaboration between surgeons and policymakers is essential and further data collection is recommended for better analysis.
气候变化对全球健康构成重大威胁，医疗保健（包括外科手术）是温室气体排放的主要来源之一。人们已经努力在外科手术中推广可持续性，但关于整形外科学可持续性的文献仍然有限。
本研究采用生命周期分析方法评估和量化非黑素瘤皮肤癌手术中三种不同重建方法（直接缝合、刃厚皮片移植和全厚皮片移植）相关的环境排放。分析于 2023 年 3 月在英国斯旺西莫尔森顿医院进行。然后，估算了英格兰和威尔士非黑素瘤皮肤癌手术的碳足迹。
非黑素瘤皮肤癌手术的平均碳排放量为 29.82 至 34.31 kgCO₂eq。手术室能源消耗（4.29-8.76 kgCO₂eq）和消耗品（16.87 kgCO₂eq）是主要贡献者。非黑素瘤皮肤癌手术产生的废物占 1.31 kgCO₂eq，可重复使用手术器械的消毒产生 1.92 kgCO₂eq 的碳排放。同时，运输、敷料、药品和洗衣分别占 0.57、2.65、1.85 和 0.38 kgCO₂eq。与使用刃厚皮片移植（43.80-49.06 kgCO₂eq）和全厚皮片移植（31.58-37.02 kgCO₂eq）相比，直接缝合切除非黑素瘤皮肤癌导致的碳排放量最低（19.29-22.41 kgCO₂eq）。2021 年，据估计，威尔士非黑素瘤皮肤癌手术的年碳足迹为 306775 kgCO₂eq，英格兰为 4402650 kgCO₂eq。可以预测，到 2035 年，非黑素瘤皮肤癌手术产生的碳排放将占威尔士的 388927 kgCO₂eq 和英格兰的 5419770 kgCO₂eq。
本研究强调了整形外科学中非黑素瘤皮肤癌的环境影响，强调了需要采取可持续实践。外科医生和政策制定者之间的合作至关重要，建议进一步收集数据以进行更好的分析。
