Comparative carbon footprinting study of reusable vs. disposable instruments in cataract surgery

Abstract

Theatre activity is a major source of hospital waste, accounting for 21–30% of total output, and is 3–6 times more energy-intensive than any other hospital department. Cataract remains the leading cause of blindness worldwide, and cataract surgery is the most commonly performed surgical procedure worldwide, but to date has received little analysis in this field. The aim of this study was to evaluate the carbon impact of streamlining single-use packs, and transitioning from single-use items, to reusable equivalents in cataract surgery. A focus group and prospective audit was carried out to identify single-use pack items for streamlining. A bottom-up, process-based carbon footprint analysis was conducted of single-use items and reusable alternatives using activity data provided by the suppliers and greenhouse gas (GHG) conversion factors from the UK Government GHG Conversion Factors for Company Reporting database. Total carbon savings from streamlining was 935 kgCO2e/year, and switching, was 309 kgCO2e/year. Single-use items had a 27 times greater carbon footprint than reusable equivalents (322 kgCO2 vs. 12 kgCO2e respectively). A net carbon saving was achieved from 19 or more re-uses of the reusable items compared to single-use equivalents. This study provides evidence of carbon emissions savings both from streamlining disposable instruments in cataract surgical packs, and from switching from single-use to reusable instruments. Mitigation strategies targeting hotspots in resource intensive areas will be an important aspect of reducing the climate burden of surgery. Change in practice and policy is required in all surgical specialities to realize net zero carbon healthcare.