■气候变化对人类健康构成重大威胁,和手术室(ORs)对环境的影响过大。可持续医学研究计划(PRiSM)设计了一项旨在减少浪费的小型足踝手术方案,流线型仪器托盘,尽量减少洗衣。我们进行了一项随机对照试验,以比较使用PRiSM方案与传统方案进行的程序的碳足迹。
■40名接受异物取出的成年患者,锤头矫正术,脚趾截肢,硬件拆卸,肿块切除,或腓肠肌衰退被随机分配到PRiSM或我们的“传统”方案中。PRiSM协议使用了较小的仪器托盘,更少的窗帘和毛巾,和最小的定位毯子。手术部位准备或手术技术没有改变。环境影响是使用碳足迹估算的,以千克二氧化碳当量(CO2e)为单位。与或废物相关的排放,仪器处理,和洗衣进行了计算。
■平均而言,与传统病例相比,PRiSM病例的碳足迹较小(17.3kgCO2e[SD=3.2]对20.6kgCO2e[SD=2.0],P<.001)。PRiSM病例的废物相关排放量减少(16.0kgCO2e[SD=2.7]对18.4kgCO2e[SD=1.8],P=.002),与模拟仪器处理相关的排放(0.34vs0.91kgCO2e)。每组发生1例浅表手术部位感染。
■我们发现,在使用PRiSM与传统方案时,较小的足踝手术对环境的影响略有减少,但具有统计学意义。这些案例对环境的影响主要是与塑料废物相关的排放。骨科医生应该批判性地思考他们的手术设置的哪些组件对于患者护理是真正必要的,因为产品利用率的微小变化会对废物和温室气体排放产生重大影响。
■一级,随机对照试验。
UNASSIGNED: Climate change poses a substantial threat to human health, and operating rooms (ORs) have an outsized environmental impact. The Program for Research in Sustainable Medicine (PRiSM) designed a protocol for minor foot and ankle surgery intended to reduce waste, streamline instrument trays, and minimize laundry. We conducted a randomized controlled trial to compare the carbon footprint of procedures performed using the PRiSM protocol vs a traditional protocol.
UNASSIGNED: Forty adult patients undergoing foreign body removal, hammertoe correction, toe amputation, hardware removal, mass excision, or gastrocnemius recession were randomized to the PRiSM or our \"Traditional\" protocol. The PRiSM protocol used a smaller instrument tray, fewer drapes and towels, and minimal positioning blankets. No changes were made to surgical site preparation or operative techniques. Environmental impact was estimated using the carbon footprint, measured in kilograms of carbon dioxide equivalents (CO2e). Emissions associated with OR waste, instrument processing, and laundry were calculated.
UNASSIGNED: On average, PRiSM cases had a smaller carbon footprint than Traditional cases (17.3 kg CO2e [SD = 3.2] vs 20.6 kg CO2e [SD = 2.0], P < .001). Waste-associated emissions from PRiSM cases were reduced (16.0 kg CO2e [SD = 2.7] vs 18.4 kg CO2e [SD = 1.8], P = .002), as were modeled instrument processing-related emissions (0.34 vs 0.91 kg CO2e). One superficial surgical site infection occurred in each group.
UNASSIGNED: We found a small but statistically significant reduction in the environmental impact of minor foot and ankle surgery when using the PRiSM vs Traditional protocol. The environmental impact of these cases was dominated by plastic waste-related emissions. Orthopaedic surgeons should think critically about what components of their surgical setup are truly necessary for patient care, as minor changes in product utilization can have significant impacts on waste and greenhouse gas emissions.
UNASSIGNED: Level I, randomized controlled trial.