P044 Evaluation of the CO2 Footprint of Laparoscopic Ileocecal Resection for Terminal Ileitis in Crohn's Disease

Abstract

Abstract Background Each year, huge amounts of carbon dioxide (CO2/equivalents) are generated and healthcare systems play a major role in the production of those so called greenhouse gases (GHG). The aim of this study is to assess the environmental impact, in particular the CO2 footprint, of laparoscopic ileocecal resection (ICR) for terminal ileitis in Crohn’s disease (CD) patients. Methods This is a prospective, multicentre evaluation of the carbon dioxide (CO2) emission caused by the care of CD patients undergoing laparoscopic ICR for terminal ileitis. All processes and products used during laparoscopic ICR for terminal ileitis in adult CD patients (≥16 years) between March and May 2023 were collected by one monitor. A Life Cycle Assessment (LCA) was conducted, including midpoint and endpoint analysis, to evaluate and compare the environmental impact, mainly focussing on CO2 (-equivalents), of all products and processes. Results The total CO2 footprint of a laparoscopic ICR for terminal ileitis in one CD patient (including transport of staff and patients) was 139 kg CO2eq, which equals a one way trip by car from Amsterdam to Berlin. Major contributors to CO2 emissions (“hotspots”) were transport of employees, transport of patients, medication, laparoscopic tools, electricity in theatre and a combination of standard surgery items. In addition to the carbon footprint, a significant impact on ozone formation, human carcinogenic and ecotoxicity, water consumption and mineral resource scarcity was found. The amount of disability-adjusted life years (DALY’s) as a result of the environmental impact of one laparoscopic ICR are equal to approximately 2.5 hours of health damage per laparoscopic ICR. Conclusion The “5 R principle” (refuse, reduce, reuse, repurpose, recycle) is an import aspect in reduction of the CO2 footprint and in current medical guidelines, which should be taken into account by all employees (e.g. consider traveling by train/carpooling). The total CO2 footprint of a laparoscopic ICR for terminal ileitis in one CD patient is 139 kg CO2eq. In addition to quality of life (QoL) and overall costs, the carbon footprint and overall the environmental impact of all medical procedures, should be taken into consideration and should be optimized if possible in the multimodal treatment of patients with CD terminal ileitis. Therefore, further research into the environmental impact of (medical/surgical) treatment of CD patients is warranted and more process data should become available.