PDF(Pubmed)
Abstract：
Background/Objectives: While the economic cost of adult spinal deformity (ASD) surgery has been studied extensively, its environmental impact is unknown. The aim of this study is to determine the carbon footprint (CF) associated with ASD surgery. Methods: ASD patients who underwent > four levels of corrective surgery between 2017 and 2021 were included. The open group included a posterior-only, single-stage technique, while the minimally invasive surgery (MIS) group was defined as the use of lateral interbody fusion and percutaneous posterior screw fixation. The two groups were propensity-score matched to adjust for baseline demographic, surgical, and radiographic characteristics. Data on all disposables and reusable instruments, anesthetic gas, and non-gas medications used during surgery were collected from medical records. The CF of transporting, using, and disposing of each product and the footprint of energy use in operating rooms were calculated. The CF produced was evaluated using the carbon dioxide equivalent (CO2e), which is relative to the amount of CO2 with an equivalent global warming potential. Results: Of the 175 eligible patients, 15 pairs (65 ± 9 years, 47% female) were properly matched and analyzed for all variables. The average CF generated per case was 147.7 ± 37.3 kg-CO2e, of which 54% was attributable to energy used to sterilize reusable instruments, followed by anesthetic gas released into the environment (17%) and operating room air conditioning (15%). Conclusions: The CF generated during ASD surgery should be reduced using a multidisciplinary approach, taking into account that different surgical procedures have different impacts on carbon emission sources.
摘要：
背景/目标：虽然成人脊柱畸形（ASD）手术的经济成本已被广泛研究，它对环境的影响是未知的。这项研究的目的是确定与ASD手术相关的碳足迹（CF）。方法：纳入了在2017年至2021年期间接受四级以上矫正手术的ASD患者。开放组包括一个只有后部的，单级技术，而微创手术（MIS）组定义为使用外侧椎间融合术和经皮后路螺钉固定。两组进行倾向评分匹配，以调整基线人口统计学，外科,和射线照相特征。所有一次性用品和可重复使用仪器的数据，麻醉气体,手术期间使用的非气体药物从医疗记录中收集.运输的CF，使用,并计算了每种产品的处置和手术室能源使用的足迹。使用二氧化碳当量（CO2e）评估产生的CF，这是相对于具有同等全球变暖潜能的二氧化碳的量。结果：在175名符合条件的患者中，15对(65±9岁，47%的女性)对所有变量进行了适当的匹配和分析。每例产生的平均CF为147.7±37.3kg-CO2e，其中54%归因于用于消毒可重复使用器械的能量，其次是释放到环境中的麻醉气体（17％）和手术室空调（15％）。结论：应使用多学科方法减少ASD手术期间产生的CF，考虑到不同的外科手术对碳排放源的影响不同。
