The environmental impact of an anastomotic leak care pathway in Europe

Abstract

Background: The healthcare sector faces increasing pressure to improve environmental sustainability whilst continuing to meet the needs of patients. One strategy is to lower the avoidable demand on healthcare services, by reducing the number of surgical complications, such as anastomotic leak (AL). The aim of this study was to assess the environmental impact associated with the care pathway of AL.

Methods: An environmental impact assessment was performed according to the Sustainable Healthcare Coalition (SHC) guidelines. A care pathway, describing the typical steps involved in the diagnosis and treatment of AL was developed. Activity and emission data for each stage of the care pathway were used to calculate the climate, water and waste impact of the treatment of AL patients.

Results: The environmental impact assessment shows that AL is associated with an average climate, water and waste impact per patient of 1303 kg CO2-eq, 1803 m3 of water and 123 kg waste, respectively. Grade C leaks are associated with the greatest environmental impact, contributing to 89.3 %, 79.4 % and 97.9 % of each impact, respectively. A breakdown of the environmental impact of each activity shows that stoma home management is the largest contributor to the total climate (46.6 %) and waste (47.3 %) impact of AL patients, whilst in-patient hospital stay contributes greatest to the total water impact (46.7 %).

Conclusions: The treatment of AL is associated with a substantial environmental impact. This study is, to our knowledge, the first to assess the environmental impact associated with the treatment of AL.

Research highlights

• "The treatment of anastomotic leak (AL) is associated with a substantial environmental impact. Overall, Grade C leaks are associated with the greatest environmental impact of all patients who experience a leak."
• "Reducing one AL could result in an average climate saving of 1303 kg CO2-eq (equivalent to 5 return flights from London to Rome), a water saving of 1803 m3 (equivalent to 17 times the annual water use of an average European household), and a waste saving of 123 kg (equivalent to almost 3 times the monthly waste generation of an average European individual)."
  
• "Within the anastomotic leak care pathway, stoma home management, in-patient days and surgical and radiological intervention make the largest contribution to the overall climate impact of anastomotic leak patients."
• "Whilst this study focused specifically on colorectal surgery, the findings can be applied more broadly to conclude that efforts to reduce the incidence of surgical complications and their severity may lead to improvements in the overall environmental sustainability of surgical departments."

Methods & Results

For a complete summary of this data source and to see reported environmental impact values for studied products and activities, explore the HealthcareLCA Database.

Citation

Bischofberger S, Adshead F, Moore K, Kocaman M, Casali G, Tong C, Roy S, Collins M, Brunner W. Assessing the environmental impact of an anastomotic leak care pathway. Surgery Open Science. 2023 Jul 11.