The intraoperative carbon footprint of burn surgery: A prospective case-level analysis

Healthcare contributes to approximately 4-5% of global greenhouse gas emissions. Burn surgery is particularly resource intensive; however, its environmental impact has not been quantified at the case level. We aimed to evaluate the carbon footprint of burn surgery and identify its key drivers.

A prospective observational study was conducted at a UK regional burns centre by including adult and paediatric burn procedures. Carbon emissions were calculated in kilograms of carbon dioxide equivalent (kg CO₂e) using published life-cycle assessment data and NHS emission factors. Linear and multivariable regression were used to assess the predictors of emissions.

Fifty-two procedures were analysed (in 49 adults and 3 paediatric patients; burn size 0.2-85% TBSA). Mean intraoperative carbon footprint was 158 kg CO₂e per case (range 40-875 kg CO₂e). Emissions increased by 9 kg CO₂e per 1% increase in TBSA (R²=0.75, p<0.001). Consumables accounted for 67% of total emissions, followed by theatre energy (20%) and anaesthesia (13%). Use of advanced single-use adjuncts was associated with higher emissions on univariate analysis. On an average, a single burn operation generated emissions equivalent to approximately 800 miles of petrol vehicle travel.

Burn surgery is associated with substantial intraoperative carbon emissions that scale primarily with burn size and consumable use. Although burn severity is non-modifiable, targeted measures-including adoption of reusable textiles, optimisation of theatre ventilation, rationalisation of consumables and preferential use of TIVA-offer practical opportunities to reduce environmental impact without compromising care. These data provide a quantitative benchmark for burn surgery and support integration of carbon metrics into routine audit to guide sustainable clinical practice.