Towards net-zero operating in neurosurgery.

Background: The climate crisis is one of the greatest threats to public health and surgery is a significant contributor to carbon emissions generated by the NHS. In this paper, we describe our experience of sustainable operating by using evidence-based methods to reduce our carbon footprint across three neurosurgical theatres during our 'Green operating day'.

Methods: The Green operating day was run at a single site over a 12-hour operative day and included 10 neurosurgical cases. Following discussions with the theatre, anaesthetic and sustainability team, each operative case was reviewed and changes in the consumables, surgical instruments and utilities recorded. Carbon footprint was calculated using an environmentally extended input-output model for baseline and Green operating day. Qualitative data was collected on the participants of the Green operating day to assess attitudes and behaviours towards sustainability in neurosurgery.

Results: There was a total reduction of carbon emissions by 31%, equivalent to 1.04 tonnes COe. Reductions were seen across different aspects of surgery including anaesthetics, surgical instruments, waste and utilities.

Discussion: This study demonstrates the feasibility of carbon footprint reduction within neurosurgical theatres which was not associated with increases in operative duration or adverse patient outcomes. This study advocates for environmentally conscious decision making in neurosurgical procedures.