Clay Benjamin, Hindocha Sandip, Maheshwari Kavish
Department of Trauma and Orthopaedic Surgery, East Suffolk and North Essex NHS Foundation Trust, United Kingdom; Department of Public Health and Primary Care, University of Cambridge, United Kingdom.
Department of Plastic and Reconstructive Surgery, Bedfordshire Hospitals NHS Foundation Trust, United Kingdom; Faculty of Health and Social Sciences, University of Bedfordshire, United Kingdom.
J Plast Surg Hand Surg. 2025 Apr 22;60:96-101. doi: 10.2340/jphs.v60.43375.
Free flap reconstruction procedures are renowned for their duration and the requirement for many staff and large quantities of equipment. This single-centre cross-sectional study aimed to quantify the total emissions related to two such procedures carried out at a district general hospital.
One deep inferior epigastric perforator (DIEP) free flap procedure and one anterolateral thigh (ALT) free flap procedure, both carried out in February 2024, were analysed. Data related to staff transport, anaesthetic duration, mass of disposable equipment, quantity of reusable surgical equipment and consumption of electricity and heating for the relevant theatre areas were collected. Emissions were calculated using UK government conversion factors and classified by scope and contributory element as per the Greenhouse Gas Protocol.
Total emissions were estimated at 385.5 kgCO2eq for the DIEP and 369.6 kgCO2eq for the ALT. Scope 1 emissions related to heating, atmospheric release of general anaesthetic and incineration of waste accounted for 33.7% of DIEP emissions and 35.6% of ALT emissions. Scope 2 emissions related to the use of grid electricity accounted for 44.8% of DIEP emissions and 46.7% of ALT emissions. Scope 3 emissions related to staff transport, cleaning of reusable equipment and the supply chain for disposable equipment accounted for 21.5% of DIEP emissions and 17.7% of ALT emissions.
Significant reductions in emissions may be achievable without significant infrastructural changes through initiatives to reduce staff transport by single-occupancy car, improving the energy efficiency of the theatre areas and reducing the use of single-use surgical equipment.
游离皮瓣重建手术因其手术时间长以及需要众多工作人员和大量设备而闻名。这项单中心横断面研究旨在量化一家区综合医院进行的两种此类手术的总排放量。
分析了2024年2月进行的一例腹壁下深动脉穿支（DIEP）游离皮瓣手术和一例股前外侧（ALT）游离皮瓣手术。收集了与工作人员交通、麻醉时长、一次性设备质量、可重复使用手术设备数量以及相关手术区域的电力和供暖消耗有关的数据。使用英国政府换算因子计算排放量，并根据《温室气体议定书》按范围和贡献要素进行分类。
DIEP手术的总排放量估计为385.5千克二氧化碳当量，ALT手术为369.6千克二氧化碳当量。范围一排放（与供暖、全身麻醉的大气排放和废物焚烧有关）占DIEP排放量的33.7%和ALT排放量的35.6%。范围二排放（与使用电网电力有关）占DIEP排放量的44.8%和ALT排放量的46.7%。范围三排放（与工作人员交通、可重复使用设备的清洁以及一次性设备的供应链有关）占DIEP排放量的21.5%和ALT排放量的17.7%。
通过采取措施减少单人驾车的工作人员交通、提高手术区域的能源效率以及减少一次性手术设备的使用，在不进行重大基础设施改造的情况下，有可能大幅减少排放量。
