DS14 Same-day surgery promotes sustainability in dermatology

Abstract

Abstract The healthcare sector is responsible for 4.4% of global greenhouse gas (GHG) emissions. To limit global temperature rise by 1.5 °C, as called for in the Paris Agreement, GHG emissions will need to be significantly reduced. As climate change has been labelled the greatest threat to global health in the twenty-first century, all healthcare professionals must attempt to promote sustainable practice where possible. The British Society of Dermatological Surgery sustainability guidelines published in 2022 advocate multiple strategies for improving sustainability in skin cancer surgery, including a reduction of activity via prevention measures, low-carbon alternatives, operational resource use and research and innovation. It is recommended that ‘see-and-treat clinics’ should be offered where staff and facilities are available, as one of several methods to lower the carbon footprint of dermatological surgery. We performed a cross-sectional study in a single tertiary dermatology department, focusing on carbon dioxide (CO2) emissions associated with travel to and from skin surgery appointments from 1 January 2022 to 31 December 2022. Our dermatology department is located in an urban area and also receives referrals from rural locations. The distance from the patient’s home to the hospital was calculated in kilometres using Google Maps. Total CO2 emissions were calculated using an online calculator recommended by the Environmental Protection Agency of Ireland and were reported in metric tonnes of CO2. Fuel consumption was based on the average car with unknown fuel. In total, 2358 procedures were performed on 2184 patients, 54% of whom were male (n = 1180). The total distance travelled by patients was 109 787.94 km, averaging 50.27 km per patient (range 1.3–168). This generated 18.74 metric tonnes of CO2 emissions. Eighteen per cent (n = 389) of patients underwent surgical procedures on the same day as their outpatient clinic. Same-day surgery led to a reduction of 35 275 km, averaging 90.68 km per patient (range 1.3–120). This represented a reduction of 6.02 metric tonnes of CO2 emissions. This is equivalent to the CO2 emitted from six transatlantic flights. In our department, absorbable sutures are used, where possible, to reduce unnecessary travel to our department or to a general practice for suture removal. Results for benign lesions are communicated via letter, to minimize return to the clinic. This study highlights the reduction in CO2 emissions associated with same-day dermatological surgery. The limitations of this study include an assumption of travel to and from hospital appointments by car and of travel from the address stated in patient records. Dermatologists should consider the environmental impact of skin surgery and implement sustainable options when service planning.