The Green Surgery report: a guide to reducing the environmental impact of surgical care, but will it be implemented?

In recent years, the agenda to reduce the environmental impact of surgical care has been met with enthusiasm but it has yet to achieve the scale and nature of the change we need. At least in part, that is perhaps because many surgical teams are still not sure what to do. Historically, attempts to decarbonise the UK health system were dominated by strategy to improve the efficiency of health estates and facilities.1 However, building energy, water and waste account for only 15% of the carbon footprint of the National Health Service (NHS).2 There is increasing recognition of the need for clinical leadership on this agenda and the much larger effects this could have, for example through transforming care pathways or reducing emissions from the medicines and products used to deliver care.3

Surgery is an area calling out for transformation because it is such a large contributor. Our analysis estimates the annual carbon footprint of surgical care in the UK at 5.7 million tonnes of carbon dioxide equivalents (CO2e),4 with operating theatres particularly resource-intensive (typically generating a quarter of hospital waste).5 Offsetting that would mean planting a forest three times the size of Greater London.

November 2023 saw the release of Green Surgery: Reducing the Environmental Impact of Surgical Care (Figure 1), a report funded by the Health Foundation and produced in collaboration by the UK Health Alliance on Climate Change, the Centre for Sustainable Healthcare, and our team at Brighton and Sussex Medical School.4 The report provides a compendium of current evidence and case studies on how to minimise the environmental harm of surgical care, including through disease prevention, changing care pathways, better design and use of operating theatres, and changing practice in anaesthesia.

Green Surgery is the first report of its kind by any medical specialty and badged by many organisations, including all four UK surgical colleges.4 It is intended primarily as a tool for surgical teams (surgeons, anaesthetists, nurses and operating department practitioners) but also outlines actions and recommendations for other stakeholders, including hospital managers, government, academics, industry and providers of services allied to surgical care.