Are we ready for "green surgery" to promote environmental sustainability in the operating room? Results from the WSES STAR investigation

Francesca Dal Mas; Lorenzo Cobianchi; Daniele Piccolo; Jeremy Balch; Helena Biancuzzi; Walter L Biffl; Stefano Campostrini; Enrico Cicuttin; Federico Coccolini; Dimitris Damaskos; Amanda C Filiberto; Claudia Filisetti; Gustavo Fraga; Simone Frassini; Paola Fugazzola; Timothy Hardcastle; Haytham M Kaafarani; Yoran Kluger; Maurizio Massaro; Jacopo Martellucci; Ernest Moore; Federico Ruta; Massimo Sartelli; Philip F Stahel; George Velmahos; Dieter G Weber; Fausto Catena; Tyler J Loftus; Luca Ansaloni; the STAR Study Group

doi:10.1186/s13017-024-00533-y

Are we ready for "green surgery" to promote environmental sustainability in the operating room? Results from the WSES STAR investigation

World J Emerg Surg. 2024 Jan 24;19(1):5. doi: 10.1186/s13017-024-00533-y.

Authors

Francesca Dal Mas^#^{1

2}, Lorenzo Cobianchi^#^{3

4}, Daniele Piccolo^#^{5

6}, Jeremy Balch⁷, Helena Biancuzzi⁸, Walter L Biffl⁹, Stefano Campostrini⁸, Enrico Cicuttin¹⁰, Federico Coccolini¹¹, Dimitris Damaskos¹², Amanda C Filiberto⁷, Claudia Filisetti¹³, Gustavo Fraga¹⁴, Simone Frassini^{5

10}, Paola Fugazzola^{5

10}, Timothy Hardcastle^{15

16}, Haytham M Kaafarani^{17

18}, Yoran Kluger¹⁹, Maurizio Massaro², Jacopo Martellucci²⁰, Ernest Moore²¹, Federico Ruta²², Massimo Sartelli²³, Philip F Stahel²⁴, George Velmahos^{17

18}, Dieter G Weber²⁵, Fausto Catena^#²⁶, Tyler J Loftus^#⁷, Luca Ansaloni^#^{5

10}; the STAR Study Group

Affiliations

¹ Collegium Medicum, University of Social Sciences, Łodz, Poland.
² Department of Management, Ca' Foscari University, Venice, Italy.
³ Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy. lorenzo.cobianchi@unipv.it.
⁴ General Surgery, Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy. lorenzo.cobianchi@unipv.it.
⁵ Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Via Alessandro Brambilla, 74, 27100, Pavia, PV, Italy.
⁶ Unit of Neurosurgery, Department of Head-Neck and Neuroscience, ASUFC Santa Maria Della Misericordia, Udine, Italy.
⁷ Department of Surgery, University of Florida Health, Gainesville, FL, USA.
⁸ Department of Economics, Ca' Foscari University, Venice, Italy.
⁹ Division of Trauma and Acute Care Surgery, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA.
¹⁰ General Surgery, Department, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
¹¹ General, Emergency and Trauma Surgery Dept, Pisa University Hospital Pisa, Pisa, Italy.
¹² General and Emergency Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
¹³ Department of Pediatric Surgery, Buzzi Children's Hospital, Milan, Italy.
¹⁴ Division of Trauma Surgery, Department of Surgery, School of Medical Sciences, University of Campinas (Unicamp), Campinas, SP, Brazil.
¹⁵ Department of Surgical Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu-Natal, Durban, 4001, South Africa.
¹⁶ Trauma and Burns Services, Inkosi Albert Luthuli Central Hospital, Mayville, 4058, South Africa.
¹⁷ Harvard Medical School, Boston, MA, USA.
¹⁸ Division of Trauma, Emergency Surgery, and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA.
¹⁹ Division of General Surgery, Rambam Health Care Campus, Haifa, Israel.
²⁰ Department of Surgery, Careggi University Hospital, Florence, Italy.
²¹ Ernest E Moore Shock Trauma Center at Denver Health, Denver, CO, USA.
²² General Direction, ASL BAT (Health Agency), Andria, Italy.
²³ Department of Surgery, Macerata Hospital, Macerata, Italy.
²⁴ Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
²⁵ Department of General Surgery, Royal Perth Hospital, University of Western Australia, Perth, Australia.
²⁶ Acute Care Surgery Unit, Department of Surgery and Trauma, Maurizio Bufalini Hospital, Cesena, Italy.

^# Contributed equally.

Abstract

Background: The importance of environmental sustainability is acknowledged in all sectors, including healthcare. To meet the United Nations Sustainable Development Goals 2030 Agenda, healthcare will need a paradigm shift toward more environmentally sustainable practices that will also impact clinical decision-making. The study investigates trauma and emergency surgeons' perception, acceptance, and employment of environmentally friendly habits.

Methods: An online survey based on the most recent literature regarding environmental sustainability in healthcare and surgery was created by a multidisciplinary committee and endorsed by the World Society of Emergency Surgery (WSES). The survey was advertised to the 917 WSES members through the society's website and Twitter/X profile.

Results: 450 surgeons from 55 countries participated in the survey. Results underline both a generally positive attitude toward environmental sustainability but also a lack of knowledge about several concepts and practices, especially concerning the potential contribution to patient care.

Discussion: The topic of environmental sustainability in healthcare and surgery is still in its infancy. There is a clear lack of salient guidance and knowledge, and there is a critical need for governments, institutions, health agencies, and scientific societies to promote, disseminate, and report environmentally friendly initiatives and their potential impacts while employing an interdisciplinary approach.

Keywords: Environmental Sustainability; Sustainability; Trauma and emergency surgery; survey; Green.

MeSH terms

Clinical Decision-Making
Humans
Operating Rooms
Orthopedic Procedures*
Surgeons*