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Evidence-based Integration of Environmental Sustainability into Clinical Guidelines for Operating Rooms: A Systematic
Kim E van Nieuwenhuizen1, Charlotte T J Michels2, Ingena G I A Both1
1Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.
Objective:
To assess the feasibility of integrating environmental sustainability into clinical guidelines for operating rooms (ORs) and provide evidence-based recommendations.
Background:
Surgical practices contribute significantly to health care's environmental impact. Incorporating sustainability into evidence-based clinical guidelines can support environmentally responsible decision-making. However, guidance on integrating environmental considerations into clinical recommendations remains limited.
Methods:
A systematic review was conducted on the environmental impact of ORs, focusing on 5 key topics: (1) surgical techniques, (2) disposables versus reusables, (3) cover materials, (4) anaesthesia, and (5) OR ventilation. The search was conducted in December 2022 in PubMed (through NCBI), Embase (through OVID), Web of Science (through Webofscience), Cochrane (through Cochrane Library), and Emcare (through OVID). The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence and formulate recommendations.
Results:
A total of 42 studies were included, of which 28 employed life cycle assessment (LCA) methods. Grading of Recommendations, Assessment, Development, and Evaluation assessments indicated "very low" to "low" quality of evidence. Key contributors to the OR environmental impact included energy-intensive and resource-intensive surgical technologies, reliance on disposables, anaesthetic gas emissions, and energy consumption for OR ventilation.
Conclusions:
Despite "very low" to "low" levels of evidence, environmental outcomes consistently point in the same direction. Studies using LCA methods are instrumental in identifying environmental hotspots for targeted mitigation. Integrating LCA findings into clinical guidelines can support sustainability efforts in surgery, helping guideline panels develop evidence-based recommendations that promote environmentally responsible practices.
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