Sustainability in Reconstructive Breast Surgery: An Eco-audit of the Deep Inferior Epigastric Perforator Flap Pathway
Background:. The deep inferior epigastric perforator (DIEP) flap provides an effective and popular means for autologous breast reconstruction. However, with the complexity of the pathway, the environmental impact of the pathway has yet to be evaluated. Methods:. A retrospective analysis of 42 unilat...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer
2024-12-01
|
| Series: | Plastic and Reconstructive Surgery, Global Open |
| Online Access: | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006374 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832589703681933312 |
|---|---|
| author | Zahra Ahmed, BSc (Hons) Alexander Zargaran, MRCS David Zargaran, MRCS Sara Sousi, MRes Keiron Hakimnia Sevasti Panagiota Glynou, BSc (Hons) Julie Davies, PhD Stephen Hamilton, FRCS (Plast) Afshin Mosahebi, FRCS (Plast) |
| author_facet | Zahra Ahmed, BSc (Hons) Alexander Zargaran, MRCS David Zargaran, MRCS Sara Sousi, MRes Keiron Hakimnia Sevasti Panagiota Glynou, BSc (Hons) Julie Davies, PhD Stephen Hamilton, FRCS (Plast) Afshin Mosahebi, FRCS (Plast) |
| author_sort | Zahra Ahmed, BSc (Hons) |
| collection | DOAJ |
| description | Background:. The deep inferior epigastric perforator (DIEP) flap provides an effective and popular means for autologous breast reconstruction. However, with the complexity of the pathway, the environmental impact of the pathway has yet to be evaluated.
Methods:. A retrospective analysis of 42 unilateral DIEPs at a single reconstructive center was performed. Process mapping and life-cycle analyses were performed for equipment, staff, patients, and land. A bottom-up approach was adopted to calculate carbon dioxide equivalent estimates for the initial consultation, preoperative, intraoperative, and immediate postoperative periods.
Results:. This study estimated the carbon footprint of a patient undergoing DIEP flap surgery to be approximately 233.96 kg CO2eq. Induction, maintenance, and running of anesthesia had the highest overall contribution to the carbon footprint (158.17 kg CO2eq, 67.60% overall). Patient and staff travel contributed more than 15% overall carbon emissions in this study. The impact of sterilization was less than half of that from waste management (0.81 versus 1.81 kg CO2eq, respectively). Waste management alone contributed 4.21 kg CO2eq of the overall carbon emissions, the majority of which was accountable to the incineration of 14.75 kg of noninfectious offensive waste.
Conclusions:. This study estimates the carbon footprint of the DIEP pathway. Strategies to mitigate the impact of carbon emissions including usage of reusable vs single-use equipment, virtual consultations, standardization of equipment packs, and optimizing waste disposal were suggested areas for improvement. Data from manufacturers on life-cycle assessments were limited, and further work is needed to fully understand and optimize the impact of DIEP surgery on the environment. |
| format | Article |
| id | doaj-art-6b67ce927b48489f8659f47ad4b96316 |
| institution | Kabale University |
| issn | 2169-7574 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Wolters Kluwer |
| record_format | Article |
| series | Plastic and Reconstructive Surgery, Global Open |
| spelling | doaj-art-6b67ce927b48489f8659f47ad4b963162025-01-24T09:19:45ZengWolters KluwerPlastic and Reconstructive Surgery, Global Open2169-75742024-12-011212e637410.1097/GOX.0000000000006374202412000-00064Sustainability in Reconstructive Breast Surgery: An Eco-audit of the Deep Inferior Epigastric Perforator Flap PathwayZahra Ahmed, BSc (Hons)0Alexander Zargaran, MRCS1David Zargaran, MRCS2Sara Sousi, MRes3Keiron Hakimnia4Sevasti Panagiota Glynou, BSc (Hons)5Julie Davies, PhD6Stephen Hamilton, FRCS (Plast)7Afshin Mosahebi, FRCS (Plast)8From the * Division of Surgery and Interventional Science, University College London, London, United KingdomFrom the * Division of Surgery and Interventional Science, University College London, London, United KingdomFrom the * Division of Surgery and Interventional Science, University College London, London, United KingdomFrom the * Division of Surgery and Interventional Science, University College London, London, United KingdomFrom the * Division of Surgery and Interventional Science, University College London, London, United Kingdom‡ Faculty of Medicine, Imperial College London, London, United Kingdom.From the * Division of Surgery and Interventional Science, University College London, London, United Kingdom† Department of Plastic and Reconstructive Surgery, Royal Free NHS Foundation Trust, London, United KingdomFrom the * Division of Surgery and Interventional Science, University College London, London, United KingdomBackground:. The deep inferior epigastric perforator (DIEP) flap provides an effective and popular means for autologous breast reconstruction. However, with the complexity of the pathway, the environmental impact of the pathway has yet to be evaluated. Methods:. A retrospective analysis of 42 unilateral DIEPs at a single reconstructive center was performed. Process mapping and life-cycle analyses were performed for equipment, staff, patients, and land. A bottom-up approach was adopted to calculate carbon dioxide equivalent estimates for the initial consultation, preoperative, intraoperative, and immediate postoperative periods. Results:. This study estimated the carbon footprint of a patient undergoing DIEP flap surgery to be approximately 233.96 kg CO2eq. Induction, maintenance, and running of anesthesia had the highest overall contribution to the carbon footprint (158.17 kg CO2eq, 67.60% overall). Patient and staff travel contributed more than 15% overall carbon emissions in this study. The impact of sterilization was less than half of that from waste management (0.81 versus 1.81 kg CO2eq, respectively). Waste management alone contributed 4.21 kg CO2eq of the overall carbon emissions, the majority of which was accountable to the incineration of 14.75 kg of noninfectious offensive waste. Conclusions:. This study estimates the carbon footprint of the DIEP pathway. Strategies to mitigate the impact of carbon emissions including usage of reusable vs single-use equipment, virtual consultations, standardization of equipment packs, and optimizing waste disposal were suggested areas for improvement. Data from manufacturers on life-cycle assessments were limited, and further work is needed to fully understand and optimize the impact of DIEP surgery on the environment.http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006374 |
| spellingShingle | Zahra Ahmed, BSc (Hons) Alexander Zargaran, MRCS David Zargaran, MRCS Sara Sousi, MRes Keiron Hakimnia Sevasti Panagiota Glynou, BSc (Hons) Julie Davies, PhD Stephen Hamilton, FRCS (Plast) Afshin Mosahebi, FRCS (Plast) Sustainability in Reconstructive Breast Surgery: An Eco-audit of the Deep Inferior Epigastric Perforator Flap Pathway Plastic and Reconstructive Surgery, Global Open |
| title | Sustainability in Reconstructive Breast Surgery: An Eco-audit of the Deep Inferior Epigastric Perforator Flap Pathway |
| title_full | Sustainability in Reconstructive Breast Surgery: An Eco-audit of the Deep Inferior Epigastric Perforator Flap Pathway |
| title_fullStr | Sustainability in Reconstructive Breast Surgery: An Eco-audit of the Deep Inferior Epigastric Perforator Flap Pathway |
| title_full_unstemmed | Sustainability in Reconstructive Breast Surgery: An Eco-audit of the Deep Inferior Epigastric Perforator Flap Pathway |
| title_short | Sustainability in Reconstructive Breast Surgery: An Eco-audit of the Deep Inferior Epigastric Perforator Flap Pathway |
| title_sort | sustainability in reconstructive breast surgery an eco audit of the deep inferior epigastric perforator flap pathway |
| url | http://journals.lww.com/prsgo/fulltext/10.1097/GOX.0000000000006374 |
| work_keys_str_mv | AT zahraahmedbschons sustainabilityinreconstructivebreastsurgeryanecoauditofthedeepinferiorepigastricperforatorflappathway AT alexanderzargaranmrcs sustainabilityinreconstructivebreastsurgeryanecoauditofthedeepinferiorepigastricperforatorflappathway AT davidzargaranmrcs sustainabilityinreconstructivebreastsurgeryanecoauditofthedeepinferiorepigastricperforatorflappathway AT sarasousimres sustainabilityinreconstructivebreastsurgeryanecoauditofthedeepinferiorepigastricperforatorflappathway AT keironhakimnia sustainabilityinreconstructivebreastsurgeryanecoauditofthedeepinferiorepigastricperforatorflappathway AT sevastipanagiotaglynoubschons sustainabilityinreconstructivebreastsurgeryanecoauditofthedeepinferiorepigastricperforatorflappathway AT juliedaviesphd sustainabilityinreconstructivebreastsurgeryanecoauditofthedeepinferiorepigastricperforatorflappathway AT stephenhamiltonfrcsplast sustainabilityinreconstructivebreastsurgeryanecoauditofthedeepinferiorepigastricperforatorflappathway AT afshinmosahebifrcsplast sustainabilityinreconstructivebreastsurgeryanecoauditofthedeepinferiorepigastricperforatorflappathway |