The Environmental Impact of Bronchoscopy: A Systematic Review

PURPOSE: The healthcare sector's contribution to global net emissions stands at 4.4%, amounting to 2 gigatons of carbon dioxide equivalent. Global heath and net zero plans have stressed the need for environmental impact to be considered as part of decision making in bronchoscopy, as well as for other procedures.

We sought to provide a systematic literature review of studies assessing the environmental impact of bronchoscopy procedures. This review marks the first attempt to assess the quality of published Life Cycle Assessments (LCAs).

METHODS: Embase, Pubmed, DTU find-it, HealthcareLCA and Google Scholar were searched through 01.01.1990 to 01.03.2024, in accordance with PRISMA guidelines. Inclusion criteria were studies measuring the environmental impact of bronchoscopy procedures.

ISO 14044 2006 Environmental management — Life cycle assessment — Requirements and guidelines, §5.2, an international standard specifying requirements and providing guidelines for life cycle assessment (LCA) was used as a checklist. Each study was scored between 0 – 2 for subcategories of 1) General aspects, 2) Goal of the study, 3) Scope of the study, 4) Life cycle inventory analysis, 5) Life cycle impact assessment, 6) Life cycle interpretation, and 7) Critical review, where applicable, with 2 demonstrating full compliance with LCA standards.

RESULTS: 1013 studies were identified of which three studies met inclusion criteria. Two studies sought to measure the life cycle of single-use and reusable bronchoscopes; A study by Bringier et al. 2023 estimated single-use bronchoscopes to generate 3,9 kg CO2-e/procedure compared to 2,9kg CO2-e/procedure for reusable bronchoscopes, and scored 28 out of 66 points on the LCA checklist. A study by Sørensen et al. 2018 estimated single-use bronchoscopes to generate 1,6 kg CO2-e/procedure compared to 2,9 kg Co2-e/procedure for reusable bronchoscopes and scored 20 out of 66 points on the LCA checklist. One study by Patrucco et al. 2023 sought to quantify waste, energy consumption and recyclability of bronchoscopy procedures. The study found an average waste of 1 kg/procedure generated with 15.8% being potentially recyclable. Nearly twofold more recyclable waste was found to be generated from single-use instruments compared to reusable, of which 80% came from the procedure phase. Reusable instruments generated 45% of waste during the reprocessing phase, 50% of which was recyclable. An average 1,06 kWh was consumed per procedure and 6,7 kg CO2-e due to non-recyclable waste and energy consumption. This study did not seek to complete a full LCA and therefore scored 11 out of 66 points on the LCA checklist.

CONCLUSIONS: While existing research seeks to provide a foundation for understanding the environmental impact of bronchoscopy procedures, these findings highlight the need for further research and in-depth LCAs in accordance with international standards.

CLINICAL IMPLICATIONS: There is a need for further, in-depth LCAs performed in accordance with international standards to guide on practical interventions to mitigate the environmental impact of bronchoscopy and encourage the development of new practices, fostering the progression towards a more sustainable specialty.