Sustainability in Abdominal Wall Reconstruction: An Eco-Audit of the Abdominal Wall Reconstruction Pathway

This study aimed to perform process mapping and life cycle assessment of patients who underwent abdominal wall reconstruction to identify actionable carbon hotspots, decrease emissions, and increase sustainability.

Abdominal wall reconstruction is a procedure requiring input from multiple specialities and is often performed on complex multimorbid patients requiring a high level of care, the environmental impact of which has yet to be explored.

A retrospective study was conducted on 30 patients who underwent abdominal wall reconstruction at a single center. Process mapping and life-cycle analyses were performed for surgical and inpatient stay, as well as preoperative and outpatient evaluation including facilities, consumables, medical gases, equipment, food and linen, and travel. Estimates for carbon dioxide emissions were generated for each stage, with variability considered, as well as potential areas for savings.

This study estimated the carbon footprint of a patient undergoing abdominal wall reconstruction surgery to be approximately 420.56 kgCO₂eq. Inpatient stay had the highest overall contribution to the carbon footprint (316.9 kgCO₂eq., 75.4% pathway emissions). From non-inpatient analysis, patient travel was the predominant source of carbon emissions (51.8 kgCO₂eq, 50.0%) followed by the production and transport of equipment and building electricity, gas, oil, and water usage.

This is the first study to estimate the carbon footprint of a surgical pathway for complex patients, using abdominal wall reconstruction as an example. Strategies to combat the impact of carbon emissions and increase sustainability included greater implementation of enhanced recovery after surgery protocols to reduce inpatient stay, improved accuracy of waste segregation, and continued use of total intravenous anesthesia.