McGain Forbes, Wickramarachchi Kasun, Aye Lu, Chan Brandon G, Sheridan Nicole, Tran Phong, McAlister Scott
Department of Critical Care, Medicine, Dentistry and Health Sciences, University of Melbourne, Vic, Australia; and Department of Anaesthesia, Western Health, Melbourne, Vic, Australia; and Department of Intensive Care, Western Health, Footscray, Melbourne, Vic 3011, Australia.
Department of Anaesthesia and Perioperative Medicine, Royal Melbourne Hospital, Melbourne, Vic, Australia.
Aust Health Rev. 2024 Dec;48(6):664-672. doi: 10.1071/AH24154.
Objective Detailed quantifications of the environmental footprint of operations that include surgery, anaesthesia, and engineering are rare. We examined all such aspects to find the greenhouse gas emissions of an operation. Methods We undertook a life cycle assessment of 10 patients undergoing total knee replacements, collecting data for all surgical equipment, energy requirements for cleaning, and operating room energy use. Data for anaesthesia were sourced from our prior study. We used life cycle assessment software to convert inputs of energy and material use into outputs in kg CO2 e emissions, using Monte Carlo analyses with 95% confidence intervals. Results The average carbon footprint was 131.7kg CO2 e, (95% confidence interval: 117.7-148.5kg CO2 e); surgery was foremost (104/131.7kg CO2 e, 80%), with lesser contributions from anaesthesia (15.0/131.7kg CO2 e, 11%), and engineering (11.9/131.7kg CO2 e, 9%). The main surgical sources of greenhouse gas emissions were: energy used to disinfect and steam sterilise reusable equipment (43.4/131.7kg CO2 e, 33%), single-use equipment (34.2/131.7kg CO2 e, 26%), with polypropylene alone 13.7/131.7kg CO2 e (11%), and the knee prosthesis 19.6kg CO2 e (15%). For energy use, the main contributors were: gas heating (6.7kg CO2 e) and heating, cooling, and fans (4kg CO2 e). Conclusions The carbon footprint of a total knee replacement was equivalent to driving 914km in a standard 2022 Australian car, with surgery contributing 80%. Such data provide guidance in reducing an operation's carbon footprint through prudent equipment use, more efficient steam sterilisation with renewable electricity, and reduced single-use waste.
目的 对包括手术、麻醉和器械相关操作在内的医疗活动的环境足迹进行详细量化的研究较为少见。我们对所有这些方面进行了研究，以确定一台手术的温室气体排放量。方法 我们对10例接受全膝关节置换术的患者进行了生命周期评估，收集了所有手术设备的数据、清洁所需能量以及手术室能源使用情况。麻醉数据来源于我们之前的研究。我们使用生命周期评估软件，通过蒙特卡洛分析及95%置信区间，将能源和材料使用的输入转换为以千克二氧化碳当量为单位的排放量输出。结果 平均碳足迹为131.7千克二氧化碳当量（95%置信区间：117.7 - 148.5千克二氧化碳当量）；手术是主要来源（104/131.7千克二氧化碳当量，占80%），麻醉贡献较小（15.0/131.7千克二氧化碳当量，占11%），器械相关操作贡献为（11.9/131.7千克二氧化碳当量，占9%）。温室气体排放的主要手术来源包括：用于对可重复使用设备进行消毒和蒸汽灭菌的能源（43.4/131.7千克二氧化碳当量，占33%）、一次性设备（34.2/131.7千克二氧化碳当量，占26%），其中仅聚丙烯就占13.7/131.7千克二氧化碳当量（占11%），以及膝关节假体占19.6千克二氧化碳当量（占15%）。在能源使用方面，主要贡献者包括：燃气加热（6.7千克二氧化碳当量）以及供暖、制冷和风扇（4千克二氧化碳当量）。结论 全膝关节置换术的碳足迹相当于驾驶一辆标准的2022年澳大利亚汽车行驶914公里，其中手术贡献了80%。这些数据为通过谨慎使用设备、采用可再生电力进行更高效的蒸汽灭菌以及减少一次性废物来降低手术的碳足迹提供了指导。
