Sustainability of Laparoscopic Appendectomy. Variability of Determining Factors.

Evidence shows that changes in our environment negatively affect human health, and the burden of a range of climate-sensitive health problems impacts the functioning of public health systems (1). Paradoxically, the healthcare industry itself is a major emitter of pollutants. Hospital processes generate emissions into the air, water, and soil, producing pharmaceutical, chemical, and radioactive waste that increases risks to human health (2). In the USA, the healthcare sector is responsible for 9-10% of greenhouse gas emissions, which represents 614,000 DALYs (disability-adjusted life years) (2). Today, it is clear that protecting human health without ensuring a healthy environment is counterproductive. The 2020 Helsinki Declaration calls for awareness of the strong interrelationship between human and planetary health (3).

Studying the sustainability of healthcare processes presents an opportunity to mitigate their impact. This is defined as a three-pillar concept encompassing economic, social, and environmental dimensions (4). Information on the environmental impact of a process is derived from a life cycle assessment (LCA), which identifies opportunities to improve environmental performance. To date, LCA studies in healthcare include anesthesia equipment and pharmaceuticals, central venous catheters, dental burs, custom-made disposable surgical packs, surgical instruments, medical-grade plastics, hospital gowns and textiles, and radiology equipment. They also include procedures such as childbirth, hysterectomy, hemodialysis and peritoneal dialysis, plastic surgery, cataract extraction, and intensive care, among others (4-6). However, in our review of the environmental impact of medical procedures, we did not find any sustainability studies that incorporated, in addition to LCA, a clinical effectiveness analysis such as DALYs and an economic evaluation of the intervention.

Operating rooms are the most resource-intensive areas in hospitals, with the three main contributors being energy consumption, anesthesia, and product use (4). Appendectomy is one of the most frequently performed surgeries and is associated with significant morbidity, mortality, and costs. Hospitalizations related to appendicitis cost $3 billion annually in the United States alone (5). Laparoscopic appendectomy offers the greatest benefits, with shorter hospital stays and lower perioperative morbidity (6).

Therefore, this project proposes to conduct a sustainability study of laparoscopic appendectomy. The aim is to determine the variability in resource consumption that defines the carbon footprint of each procedure. Understanding this variability will allow for the identification of gaps or practices that can lead to improved sustainability for each procedure, so that for every year of life lost due to disability or death (DALY) avoided by the procedure, it can be performed at the lowest possible cost and with the least possible environmental impact.

General Objective: To estimate the sustainability of laparoscopic appendectomy procedures performed at the Dr. Hernán Henríquez Aravena Hospital in Temuco (HHHA).