The carbon footprint of the perioperative transurethral resection of bladder tumour pathway

• Published in: BJU international 2024-07, Vol.135 (1), p.78-87
• Main Authors: John, Joseph B., Collins, Michael, Eames, Sophie, O’Flynn, Kieran, Briggs, Tim W.R., Gray, William K., McGrath, John S.
• Format: Article
• Language: English
• Subjects: Anesthesia; bladder cancer; Carbon dioxide; Carbon Footprint; Cystectomy - methods; Emissions; England; environmental impact; Greenhouse Gases; Humans; Laundry; Mitomycin C; Original; Patients; Perioperative Care - methods; Sensitivity analysis; Sterilization; Surgery; sustainability; sustainable surgery; Transurethral Resection of Bladder; Travel; Tumors; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Water use
• ISSN: 1464-4096; 1464-410X; 1464-410X
• DOI: 10.1111/bju.16477

Objectives To evaluate the carbon footprint of the perioperative transurethral resection of bladder tumour (TURBT) pathway from decision to treat to postoperative discharge, and model potential greenhouse gas (GHG) emissions reduction strategies. Materials and Methods This process‐based attributional cradle‐to‐grave life‐cycle assessment (LCA) of GHG emissions modelled the perioperative TURBT pathway at a hospital in Southwest England. We included travel, energy and water use, all reusable and consumable items, and laundry and equipment sterilisation. Resource use for 30 patients undergoing surgery was recorded to understand average GHG emissions and the inter‐case variability. Sensitivity analysis was performed for manufacturing location, pharmaceutical manufacturing carbon‐intensity, and theatre list utilisation. Results The median (interquartile range) perioperative TURBT carbon footprint was 131.8 (119.8–153.6) kg of carbon dioxide equivalent. Major pathway categories contributing to GHG emissions were surgical equipment (22.2%), travel (18.6%), gas and electricity (13.3%), and anaesthesia/drugs and associated adjuncts (27.0%), primarily due to consumable items and processes. Readily modifiable GHG emissions hotspots included patient travel for preoperative assessment, glove use, catheter use, irrigation delivery and extraction, and mitomycin C disposal. GHG emissions were higher for those admitted as inpatients after surgery. Conclusions This cradle‐to‐grave LCA found multiple modifiable GHG emissions hotspots. Key mitigation themes include minimising avoidable patient travel, rationalising equipment use, optimally filling operating theatre lists, and safely avoiding postoperative catheterisation and hospital admission where possible. A crucial next step is to design and deliver an implementation strategy for the environmentally sustainable changes demonstrated herein.