Sustainable surgery in Ireland: A national perspective on practices, perceptions, and challenges

Operating theatres significantly impact healthcare's carbon footprint. Surgeons, as key decision-makers, are essential in driving sustainable practices. This study evaluates the attitudes and practices of Irish surgeons towards environmental sustainability, identifies barriers to implementation, and explores opportunities for improvement.

A cross-sectional survey was distributed to members and fellows of the Royal College of Surgeons in Ireland (RCSI). The structured questionnaire comprised demographic items, Likert-scale statements, and open-ended questions, addressing awareness of sustainability, waste management behaviours, and individual commitment to sustainable practices.

A total of 177 responses (response rate of 85.9 %) were received; 74 % (n = 131) of respondents were male and 55.4 % (n = 98) were consultant surgeons. While most respondents acknowledged the importance of sustainability in surgery, many reported limited familiarity with the concept. The volume of non-clinical waste generated in surgical settings was frequently underestimated. Reported barriers to implementing sustainable practices included insufficient education and awareness, financial constraints, and dependence on single-use instruments. Concerns regarding sterility and infection prevention also emerged as deterrents to adopting reusable alternatives. In addition to the quantitative findings, open-ended responses were analysed using thematic analysis, which revealed nuanced insights into surgeons' perceptions of sustainability, including underlying concerns, motivations, and system-level barriers.

There is a clear disconnect between the perceived importance of sustainability and its practical application in surgical settings. Barriers exist at multiple levels - individual, institutional, and systemic. These findings underscore the urgent need for targeted educational and policy-driven interventions to embed sustainability into surgical practice.