子宫切除术子宫操纵器的碳足迹与成本比较分析
A Comparative Carbon Footprint and Cost Analysis of Uterine Manipulators for Hysterectomy.
作者信息
Melnyk Alexandra I, Silva de Souza Lima Cano Nathalia, Glass Clark Stephanie, Bilec Melissa M, Artsen Amanda
机构信息
Ob/Gyn & Women's Health Institute, Division of Urogynecology and Reconstructive Pelvic Surgery, Cleveland Clinic, Cleveland, Ohio; and the Department of Civil and Environmental Engineering, Swanson School of Engineering, and the Mascaro Center for Sustainable Innovation, University of Pittsburgh, the Division of Urogynecology and Pelvic Reconstructive Surgery, Magee-Womens Hospital, University of Pittsburgh Medical Center, and the Magee-Womens Research Institute, Pittsburgh, Pennsylvania.
出版信息
Obstet Gynecol. 2025 May 22;146(1):104-112. doi: 10.1097/AOG.0000000000005949.
OBJECTIVE
To evaluate the environmental effects and cost of four different uterine manipulators using life cycle assessment and life cycle costing.
METHODS
Life cycle assessment, which evaluates the environmental effects of a product or process throughout its life cycle, including production, use, and disposal, was performed on a reusable stainless-steel manipulator, two disposable manipulators, and a hybrid manipulator with both reusable and disposable pieces. Uncertainty in data was addressed through Monte Carlo analysis. Life cycle costing was conducted concurrently, incorporating procurement, sterilization, and waste removal costs and excluding capital equipment costs. Costs were estimated from institutional contracts, labor, materials, and energy use. The primary outcome of this study was the environmental footprint of four uterine manipulators. Secondarily, we compared the global warming potential (kilograms of CO 2 -equivalents) and costs (U.S. dollars) associated with the production, use, sterilization, and disposal of these manipulators over 300 hysterectomies, the approximate life of the reusable manipulator.
RESULTS
The reusable stainless-steel manipulator had the lowest carbon footprint and environmental effect in every category. The disposable manipulators had global warming emissions 4.24 and 2.39 times higher than the reusable manipulator, and the hybrid had emissions 3.76 times higher at 15 uses. Sterilization contributed most of the effects for the reusable manipulator, and production contributed the most for the other devices. The reusable manipulator had the highest up-front costs, but over 300 uses saved the institution $16,000-43,000 compared with the other devices.
CONCLUSION
The reusable stainless-steel uterine manipulator had the lowest carbon footprint and cost compared with the disposable and hybrid devices over their life cycles. Health care leadership should invest in reusable devices; clinicians should prioritize reusable options; and industry partners should innovate and manufacture stainless-steel instruments to help decarbonize the health care system.
目的
使用生命周期评估和生命周期成本核算来评估四种不同子宫操纵器的环境影响和成本。
方法
对一种可重复使用的不锈钢操纵器、两种一次性操纵器以及一种兼具可重复使用和一次性部件的混合操纵器进行了生命周期评估，该评估可评估产品或过程在其整个生命周期（包括生产、使用和处置）中的环境影响。通过蒙特卡洛分析解决数据中的不确定性。同时进行生命周期成本核算，纳入采购、消毒和废物清除成本，不包括资本设备成本。成本根据机构合同、劳动力、材料和能源使用情况进行估算。本研究的主要结果是四种子宫操纵器的环境足迹。其次，我们比较了在300例子宫切除术中（即可重复使用操纵器的大致使用寿命），这些操纵器的生产、使用、消毒和处置所产生的全球变暖潜能值（二氧化碳当量千克数）和成本（美元）。
结果
可重复使用的不锈钢操纵器在各个类别中碳足迹和环境影响最低。一次性操纵器的全球变暖排放量比可重复使用操纵器高4.24倍和2.39倍, 混合操纵器在使用15次时排放量高3.76倍。消毒对可重复使用操纵器的影响最大，而生产对其他设备的影响最大。可重复使用操纵器前期成本最高，但与其他设备相比，在使用300次时为机构节省了16,000 - 43,000美元。
结论
与一次性和混合设备相比，可重复使用的不锈钢子宫操纵器在其生命周期内碳足迹和成本最低。医疗保健领导层应投资于可重复使用的设备；临床医生应优先选择可重复使用的选项；行业合作伙伴应进行创新并制造不锈钢器械，以帮助医疗保健系统实现脱碳。
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