Decision-making Factors in Surgical Techniques and Attitudes Towards Environmental Sustainability

Our study examines factors influencing surgical specialists' choice of surgical technique and assesses the significance of the carbon footprint in this decision-making process. It also investigates their attitudes, behaviors, and barriers to environmental sustainability.

Climate change significantly threatens health, with surgery being a major contributor to health care's carbon footprint.

A cross-sectional study was conducted using a discrete choice experiment (DCE) and a questionnaire. Respondents were Dutch-speaking surgeons, gynecologists, and urologists with experience in minimally invasive surgery. They judged 14 choice sets, each presenting 2 hypothetical surgical scenarios that varied in postoperative length of stay, patient's preference, specialists' experience, costs, national guideline recommendations, and carbon footprint. The questionnaire explored attitudes, behaviors, and barriers to environmental sustainability.

Among the 116 respondents, patient's preference emerged as the most important factor in the choice of a surgical technique [relative importance (RI) 27.35 (95% CI: 19.57-35.12], followed by postoperative length of stay [RI 21.41 (95% CI: 14.07-28.75)], specialists' experience [RI 16.07 (95% CI: 11.45-20.69)], costs [RI 13.98 (95% CI: 8.42-19.55)], national guideline recommendations [RI 13.29 (95% CI: 8.41-18.16)] and carbon footprint [RI 7.90 (95% CI: 3.63-12.18)]. Respondents expressed concern about climate change (105/116; 90%), with 85% (98/116) altering personal behaviors, and 49% (57/116) changing work practices. They feel surgical specialists have a responsibility to be aware of surgery's environmental impact (97/116; 84%), and a part has the knowledge to decrease this impact (39/116; 34%). The main barriers are time (73/116; 63%), costs (74/116; 64%), and inadequate training and information (67/116; 58%).

Patient preference and postoperative length of stay are prioritized in surgical decision-making, while carbon footprint is the least significant factor. To enhance sustainability in surgical practice, barriers must be addressed, and sustainable techniques and devices should be developed and standardized, ensuring sustainability is inherent in the available options, rather than just relying on individual choice.