Environmental impact of the enhanced recovery pathway in colorectal surgery: A simulation study

AimMost of the literature on the environmental impact of surgery has analysed operating theatre practice in terms of its contribution to global warming (by greenhouse gas effects). The aim of this study was to assess the overall environmental impact of a complete perioperative pathway with and without implementation of an enhanced recovery programme (ERP).MethodWe compared two scenarios: an ERP scenario and a conventional scenario (CONV) for colorectal surgery. We carried out a lifecycle analysis for perioperative procedures, devices and consumables. We measured the impact on 17 environmental variables in addition to global warming.ResultsThe overall environmental impact of ERP was 6% lower than that of conventional care. The reduction of impact due to ERP ranged from 5% for greenhouse gas emissions (18 kg CO2 equivalent less per intervention) to 27% for water consumption (3 m3 less). The stages that had the most impact on the environment were the preoperative stage (essentially owing to patient travel) and the intraoperative stage with the surgical part (medical devices representing 83.3% of the impact of the procedure) and the anaesthesia part (halogenated gases and ventilation representing 54.9% of the impact of anaesthesia care).ConclusionThis study found an ERP approach to be more eco-responsible than conventional care. This is an additional benefit of ERP implementation. The impact of ERP implementation might be further reduced by action on the preoperative and intraoperative stages.