What Is the Carbon Footprint of Adult Spinal Deformity Surgery?
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patient Selection
2.2. Carbon Footprint Calculations
2.3. Single-Use Disposable Items, Reusable Instruments, and Non-Gas Medications
2.4. Inhalational Anesthetic Gas
÷ [2412 × Density (g/mL)]
2.5. Energy Consumption in ORs
2.6. Statistical Analyses
3. Results
3.1. Patient Characteristics and Surgical Factors
3.2. The CF Produced in ASD Surgery
3.3. The Impact of Anesthesia Time on CF
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
- -
- North America
- ·
- Puerto Rico: The Port of San Juan (1805 nm);
- ·
- Dominican Republic: The Port of Caucedo (1732 nm).
- -
- Europe
- ·
- Germany and Switzerland: The Port of Hamburg (4195 nm);
- ·
- Denmark: The Port of Aarhus (3975 nm);
- ·
- Italy: Porto di Gioia Tauro (4658 nm);
- ·
- Sweden: The Port of Gothenburg (3859 nm);
- ·
- Spain: The Port of Algecuras (3557 nm).
- -
- Asia
- ·
- China: Shanghai Port (13,903 nm);
- ·
- Hong Kong: Hong Kong Port (13,402 nm);
- ·
- Malaysia: Port Klang (11,017 nm);
- ·
- Singapore: The Port of Singapore (11,247 nm);
- ·
- India: Mumbai Port (9078 nm).
Appendix B
Appendix C
Molar Mass (g/mol) | Density (g/mL) | GWP100 * | |
Sevoflurane † | 200.1 | 1.22 | 130 |
Isoflurane † | 184.5 | 1.50 | 510 |
Desflurane † | 168 | 1.47 | 2540 |
N2O † | 44 | 1.98 | 298 |
* GWP100 value indicates the effectiveness of each gas in capturing heat in the Earth’s atmosphere over a century, serving as the conversion unit for each agent compared to CO2. † [40]. |
References
- Watts, N.; Adger, W.N.; Agnolucci, P.; Blackstock, J.; Byass, P.; Cai, W.; Chaytor, S.; Colbourn, T.; Collins, M.; Cooper, A.; et al. Health and Climate Change: Policy Responses to Protect Public Health. Lancet 2015, 386, 1861–1914. [Google Scholar] [CrossRef]
- Ebi, K.L.; Vanos, J.; Baldwin, J.W.; Bell, J.E.; Hondula, D.M.; Errett, N.A.; Hayes, K.; Reid, C.E.; Saha, S.; Spector, J.; et al. Extreme Weather and Climate Change: Population Health and Health System Implications. Annu. Rev. Public Health 2021, 42, 293–315. [Google Scholar] [CrossRef]
- Rizan, C.; Steinbach, I.; Nicholson, R.; Lillywhite, R.; Reed, M.; Bhutta, M.F. The Carbon Footprint of Surgical Operations: A Systematic Review. Ann. Surg. 2020, 272, 986–995. [Google Scholar] [CrossRef] [PubMed]
- Eckelman, M.J.; Huang, K.; Lagasse, R.; Senay, E.; Dubrow, R.; Sherman, J.D. Health Care Pollution and Public Health Damage in the United States: An Update. Health Aff. 2020, 39, 2071–2079. [Google Scholar] [CrossRef] [PubMed]
- Dzau, V.J.; Levine, R.; Barrett, G.; Witty, A. Decarbonizing the U.S. Health Sector—A Call to Action. N. Engl. J. Med. 2021, 385, 2117–2119. [Google Scholar] [CrossRef] [PubMed]
- Stephens, B.F., 2nd; Khan, I.; Chotai, S.; Sivaganesan, A.; Devin, C.J. Drivers of Cost in Adult Thoracolumbar Spine Deformity Surgery. World Neurosurg. 2018, 118, e206–e211. [Google Scholar] [CrossRef]
- McCarthy, I.; Hostin, R.; O’Brien, M.; Saigal, R.; Ames, C.P. Health Economic Analysis of Adult Deformity Surgery. Neurosurg. Clin. N. Am. 2013, 24, 293–304. [Google Scholar] [CrossRef] [PubMed]
- Gum, J.L.; Hostin, R.; Robinson, C.; Kelly, M.P.; Carreon, L.Y.; Polly, D.W.; Bess, R.S.; Burton, D.C.; Shaffrey, C.I.; Smith, J.S.; et al. Impact of Cost Valuation on Cost-Effectiveness in Adult Spine Deformity Surgery. Spine J. 2017, 17, 96–101. [Google Scholar] [CrossRef]
- Arutyunyan, G.G.; Angevine, P.D.; Berven, S. Cost-Effectiveness in Adult Spinal Deformity Surgery. Neurosurgery 2018, 83, 597–601. [Google Scholar] [CrossRef]
- Moldovan, F.; Moldovan, L.; Bataga, T. The Environmental Sustainability Assessment of an Orthopedics Emergency Hospital Supported by a New Innovative Framework. Sustain. Sci. Pract. Policy 2023, 15, 13402. [Google Scholar] [CrossRef]
- Talibi, S.S.; Scott, T.; Hussain, R.A. The Environmental Footprint of Neurosurgery Operations: An Assessment of Waste Streams and the Carbon Footprint. Int. J. Environ. Res. Public Health 2022, 19, 5995. [Google Scholar] [CrossRef] [PubMed]
- McCarthy, I.; O’Brien, M.; Ames, C.; Robinson, C.; Errico, T.; Polly, D.W., Jr.; Hostin, R.; International Spine Study Group. Incremental Cost-Effectiveness of Adult Spinal Deformity Surgery: Observed Quality-Adjusted Life Years with Surgery Compared with Predicted Quality-Adjusted Life Years without Surgery. Neurosurg. Focus 2014, 36, E3. [Google Scholar] [CrossRef] [PubMed]
- Kodumuri, P.; Jesudason, E.P.; Lees, V. Reducing the Carbon Footprint in Carpal Tunnel Surgery inside the Operating Room with a Lean and Green Model: A Comparative Study. J. Hand Surg. 2023, 48, 1022–1029. [Google Scholar] [CrossRef] [PubMed]
- Bravo, D.; Thiel, C.; Bello, R.; Moses, A.; Paksima, N.; Melamed, E. What a Waste! The Impact of Unused Surgical Supplies in Hand Surgery and How We Can Improve. Hand 2022, 18, 1215–1221. [Google Scholar] [CrossRef]
- Delaie, C.; Cerlier, A.; Argenson, J.-N.; Escudier, J.-C.; Khakha, R.; Flecher, X.; Jacquet, C.; Ollivier, M. Ecological Burden of Modern Surgery: An Analysis of Total Knee Replacement’s Life Cycle. Arthroplast. Today 2023, 23, 101187. [Google Scholar] [CrossRef] [PubMed]
- Muschol, J.; Heinrich, M.; Heiss, C.; Hernandez, A.M.; Knapp, G.; Repp, H.; Schneider, H.; Thormann, U.; Uhlar, J.; Unzeitig, K.; et al. Economic and Environmental Impact of Digital Health App Video Consultations in Follow-up Care for Patients in Orthopedic and Trauma Surgery in Germany: Randomized Controlled Trial. J. Med. Internet Res. 2022, 24, e42839. [Google Scholar] [CrossRef] [PubMed]
- Wang, A.Y.; Ahsan, T.; Kosarchuk, J.J.; Liu, P.; Riesenburger, R.I.; Kryzanski, J. Assessing the Environmental Carbon Footprint of Spinal versus General Anesthesia in Single-Level Transforaminal Lumbar Interbody Fusions. World Neurosurg. 2022, 163, e199–e206. [Google Scholar] [CrossRef] [PubMed]
- ISO 14040:2006/Amd 1:2020; Environmental Management—Life Cycle Assessment—Principles and Framework. The International Organization for Standardization: Geneva, Switzerland, 2020. Available online: https://www.iso.org/standard/76121.html (accessed on 2 June 2024).
- McGain, F.; Sheridan, N.; Wickramarachchi, K.; Yates, S.; Chan, B.; McAlister, S. Carbon Footprint of General, Regional, and Combined Anesthesia for Total Knee Replacements. Anesthesiology 2021, 135, 976–991. [Google Scholar] [CrossRef]
- Leiden, A.; Cerdas, F.; Noriega, D.; Beyerlein, J.; Herrmann, C. Life Cycle Assessment of a Disposable and a Reusable Surgery Instrument Set for Spinal Fusion Surgeries. Resour. Conserv. Recycl. 2020, 156, 104704. [Google Scholar] [CrossRef]
- McGain, F.; Moore, G.; Black, J. Hospital Steam Sterilizer Usage: Could We Switch off to Save Electricity and Water? J. Health Serv. Res. Policy 2016, 21, 166–171. [Google Scholar] [CrossRef]
- RMW Facilities in NYS. Available online: https://www.dec.ny.gov/ (accessed on 15 August 2023).
- Corporate Social Responsibility Update. Available online: https://www.stericycle.com/content/dam/stericycle/global/documents/Stericycle-Corporate-Social-Responsibility-Report-Digital.pdf.coredownload.inline.pdf (accessed on 15 August 2023).
- Liu, J.; Laster, M.J.; Eger, E.I., 2nd; Taheri, S. Absorption and Degradation of Sevoflurane and Isoflurane in a Conventional Anesthetic Circuit. Anesth. Analg. 1991, 72, 785–789. [Google Scholar] [CrossRef] [PubMed]
- Ryan, S.M.; Nielsen, C.J. Global Warming Potential of Inhaled Anesthetics: Application to Clinical Use. Anesth. Analg. 2010, 111, 92–98. [Google Scholar] [CrossRef] [PubMed]
- MacNeill, A.J.; Lillywhite, R.; Brown, C.J. The Impact of Surgery on Global Climate: A Carbon Footprinting Study of Operating Theatres in Three Health Systems. Lancet Planet Health 2017, 1, e381–e388. [Google Scholar] [CrossRef]
- Dahle, J.S.; Patterson, P. Operating Room Design and Construction. In Operating Room Leadership and Perioperative Practice Management; Cambridge University Press: Cambridge, UK, 2018; pp. 107–121. [Google Scholar]
- Christiansen, N.; Kaltschmitt, M.; Dzukowski, F. Electrical Energy Consumption and Utilization Time Analysis of Hospital Departments and Large Scale Medical Equipment. Energy Build. 2016, 131, 172–183. [Google Scholar] [CrossRef]
- ExcelciusGPS Robotic Navigation Platform, System Specifications. Available online: https://www.globusmedical.com/musculoskeletal-solutions/excelsiustechnology/excelsiusgps/ (accessed on 16 August 2023).
- Ziehm Vision RFD 3D. Available online: https://www.ziehm.com/en/products/c-arms-with-3d-imaging/ziehm-vision-rfd-3d/ (accessed on 11 November 2023).
- McNamee, C.; Rakovac, A.; Cawley, D.T. The Environmental Impact of Spine Surgery and the Path to Sustainability. Spine 2023, 48, 545–551. [Google Scholar] [CrossRef] [PubMed]
- Tan, E.; Lim, D. Carbon Footprint of Dermatologic Surgery. Australas. J. Dermatol. 2021, 62, e170–e177. [Google Scholar] [CrossRef] [PubMed]
- Berner, J.E.; Gras, M.D.P.; Troisi, L.; Chapman, T.; Vidal, P. Measuring the Carbon Footprint of Plastic Surgery: A Preliminary Experience in a Chilean Teaching Hospital. J. Plast. Reconstr. Aesthet. Surg. 2017, 70, 1777–1779. [Google Scholar] [CrossRef]
- Beschloss, A.; Dicindio, C.; Lombardi, J.; Varthi, A.; Ozturk, A.; Lehman, R.; Lenke, L.; Saifi, C. Marked Increase in Spinal Deformity Surgery Throughout the United States. Spine 2021, 46, 1402–1408. [Google Scholar] [CrossRef]
- Greenhouse Gas Equivalencies Calculator. Available online: https://www.epa.gov/energy/greenhouse-gas-equivalencies-calculator#results (accessed on 6 November 2023).
- Woods, D.L.; McAndrew, T.; Nevadunsky, N.; Hou, J.Y.; Goldberg, G.; Yi-Shin Kuo, D.; Isani, S. Carbon Footprint of Robotically-Assisted Laparoscopy, Laparoscopy and Laparotomy: A Comparison. Int. J. Med. Robot. 2015, 11, 406–412. [Google Scholar] [CrossRef]
- Thiel, C.L.; Woods, N.C.; Bilec, M.M. Strategies to Reduce Greenhouse Gas Emissions from Laparoscopic Surgery. Am. J. Public Health 2018, 108, S158–S164. [Google Scholar] [CrossRef]
- Thiel, C.L.; Eckelman, M.; Guido, R.; Huddleston, M.; Landis, A.E.; Sherman, J.; Shrake, S.O.; Copley-Woods, N.; Bilec, M.M. Environmental Impacts of Surgical Procedures: Life Cycle Assessment of Hysterectomy in the United States. Environ. Sci. Technol. 2015, 49, 1779–1786. [Google Scholar] [CrossRef] [PubMed]
- Morris, D.S.; Wright, T.; Somner, J.E.A.; Connor, A. The Carbon Footprint of Cataract Surgery. Eye 2013, 27, 495–501. [Google Scholar] [CrossRef] [PubMed]
- Sherman, J.; Le, C.; Lamers, V.; Eckelman, M. Life Cycle Greenhouse Gas Emissions of Anesthetic Drugs. Anesth. Analg. 2012, 114, 1086–1090. [Google Scholar] [CrossRef] [PubMed]
MIS Group (N = 15) | Open Group before Matching (N = 160) | p-Value | Open Group after Matching (N = 15) | p-Value | |
---|---|---|---|---|---|
Age, years, mean ± SD | 66.0 ± 7.1 | 66.0 ± 9.9 | 0.99 | 64.5 ± 11.5 | 0.67 |
Sex, female, n (%) | 7 (46.7) | 113 (70.6) | 0.08 | 7 (46.7) | 1.00 |
BMI, kg/m | 27.3 ± 4.8 | 27.3 ± 4.8 | 0.96 | 27.7 ± 4.5 | 0.82 |
UIV at lumbar spine, n (%) | 14 (93.3) | 26 (16.3) | <0.001 | 11 (73.3) | 0.33 |
No. of fused segments | 4.7 ± 0.6 | 7.8 ± 3.3 | <0.001 | 4.9 ± 1.8 | 0.60 |
Preop PI, ° | 49.5 ± 10.9 | 55.0 ± 13.3 | 0.13 | 50.2 ± 13.6 | 0.89 |
Preop PI-LL mismatch, ° | 25.7 ± 15.3 | 22.2 ± 18.6 | 0.47 | 23.0 ± 12.5 | 0.60 |
Preop coronal Cobb, ° | 29.0 ± 13.4 | 37.2 ± 21.6 | 0.046 | 26.5 ± 18.1 | 0.67 |
Preop PT, ° | 25.7 ± 5.6 | 26.9 ± 10.1 | 0.50 | 23.9 ± 7.5 | 0.46 |
Preop TK, ° | 26.8 ± 13.3 | 35.5 ± 18.7 | 0.10 | 30.2 ± 13.2 | 0.50 |
Preop TPA, ° | 25.9 ± 10.1 | 26.1 ± 11.9 | 0.95 | 25.9 ± 22.9 | 0.41 |
SPO levels, n | 0 | 3.1 ± 2.1 | <0.001 | 1.9 ± 0.4 | <0.001 |
EBL, g | 285.0 ± 240.5 | 979.9 ± 670.3 | <0.001 | 823.3 ± 510.9 | 0.002 |
Operative time, min | 383.5 ± 100.0 | 260.3 ± 52 | <0.001 | 235.1 ± 51.7 | <0.001 |
Postop LL correction, ° | 15.7 ± 12.7 | 17.4 ± 15.6 | 0.69 | 15.5 ± 12.0 | 0.97 |
Postop TK correction, ° | 7.1 ± 11.4 | 4.6 ± 17.9 | 0.64 | 5.0 ± 13.2 | 0.70 |
Postop TPA correction, ° | 10.3 ± 9.3 | 20.4 ± 19.9 | 0.005 | 16.2 ± 11.9 | 0.20 |
MIS Group (N = 15) | Open Group (N = 15) | p Value | |
---|---|---|---|
No. of non-gas medication, mean ± SD | 48.1 ± 23.2 | 43.0 ± 9.2 | 0.44 |
No. of disposable items consumed | 88.7 ± 25.4 | 34.3 ± 7.3 | <0.001 |
No. of surgical implants * | 31.1 ± 7.6 | 39.5 ± 11.4 | 0.025 |
No. of reusable instruments | 43.9 ± 13.4 | 31.5 ± 3.7 | 0.003 |
Single-packaged instrument | 5.7 ± 2.3 | 4.4 ± 0.9 | 0.06 |
Middle-sized tray of instruments | 19.0 ± 7.6 | 16.2 ± 2.6 | 0.18 |
Container of instruments | 19.2 ± 5.6 | 10.9 ± 1.2 | <0.001 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Nakarai, H.; Kwas, C.; Mai, E.; Singh, N.; Zhang, B.; Clohisy, J.C.; Merrill, R.K.; Pajak, A.; Du, J.; Kazarian, G.S.; et al. What Is the Carbon Footprint of Adult Spinal Deformity Surgery? J. Clin. Med. 2024, 13, 3731. https://doi.org/10.3390/jcm13133731
Nakarai H, Kwas C, Mai E, Singh N, Zhang B, Clohisy JC, Merrill RK, Pajak A, Du J, Kazarian GS, et al. What Is the Carbon Footprint of Adult Spinal Deformity Surgery? Journal of Clinical Medicine. 2024; 13(13):3731. https://doi.org/10.3390/jcm13133731
Chicago/Turabian StyleNakarai, Hiroyuki, Cole Kwas, Eric Mai, Nishtha Singh, Bo Zhang, John C. Clohisy, Robert K. Merrill, Anthony Pajak, Jerry Du, Gregory S. Kazarian, and et al. 2024. "What Is the Carbon Footprint of Adult Spinal Deformity Surgery?" Journal of Clinical Medicine 13, no. 13: 3731. https://doi.org/10.3390/jcm13133731