McCance Eleanor, Steinbach Ingeborg, Morris Daniel S
Department of Ophthalmology, University Hospital of Wales, Cardiff, UK.
Centre for Sustainable Healthcare, Oxford, UK.
Eye (Lond). 2025 Jun;39(8):1481-1485. doi: 10.1038/s41433-025-03656-x. Epub 2025 Feb 13.
Theatre activity is a major source of hospital waste, accounting for 21-30% of total output, and is 3-6 times more energy-intensive than any other hospital department. Cataract remains the leading cause of blindness worldwide, and cataract surgery is the most commonly performed surgical procedure worldwide, but to date has received little analysis in this field. The aim of this study was to evaluate the carbon impact of streamlining single-use packs, and transitioning from single-use items, to reusable equivalents in cataract surgery.
A focus group and prospective audit was carried out to identify single-use pack items for streamlining. A bottom-up, process-based carbon footprint analysis was conducted of single-use items and reusable alternatives using activity data provided by the suppliers and greenhouse gas (GHG) conversion factors from the UK Government GHG Conversion Factors for Company Reporting database.
Total carbon savings from streamlining was 935 kgCO2e/year, and switching, was 309 kgCO2e/year. Single-use items had a 27 times greater carbon footprint than reusable equivalents (322 kgCO2 vs. 12 kgCO2e respectively). A net carbon saving was achieved from 19 or more re-uses of the reusable items compared to single-use equivalents.
This study provides evidence of carbon emissions savings both from streamlining disposable instruments in cataract surgical packs, and from switching from single-use to reusable instruments. Mitigation strategies targeting hotspots in resource intensive areas will be an important aspect of reducing the climate burden of surgery. Change in practice and policy is required in all surgical specialities to realize net zero carbon healthcare.
手术室活动是医院废物的主要来源，占总产出的21%-30%，且能源密集程度是医院其他任何科室的3-6倍。白内障仍是全球失明的主要原因，白内障手术是全球最常开展的外科手术，但迄今为止该领域对此几乎没有分析。本研究的目的是评估简化一次性包装以及在白内障手术中从一次性物品过渡到可重复使用等效物品对碳的影响。
开展焦点小组讨论和前瞻性审计以确定需简化的一次性包装物品。利用供应商提供的活动数据和英国政府公司报告温室气体换算因子数据库中的温室气体（GHG）换算因子，对一次性物品和可重复使用替代品进行了自下而上的基于过程的碳足迹分析。
简化操作每年可节省935千克二氧化碳当量的碳，改用可重复使用物品每年可节省309千克二氧化碳当量的碳。一次性物品的碳足迹比可重复使用等效物品大27倍（分别为322千克二氧化碳和12千克二氧化碳当量）。与一次性等效物品相比，可重复使用物品重复使用19次或更多次可实现净碳节约。
本研究证明了在白内障手术包中简化一次性器械以及从一次性器械改用可重复使用器械均可节省碳排放。针对资源密集领域热点的缓解策略将是减轻手术气候负担的一个重要方面。所有外科专业都需要改变实践和政策，以实现医疗保健的净零碳排放。
