Sustainability in hand trauma surgery: An eco-audit of the flexor tendon laceration repair pathway.

Abstract

Hand trauma accounts for nearly one-third of emergency department (ED) attendances in the United Kingdom (UK). Particularly, repair of flexor tendon injuries is one of the most commonly performed plastic surgery procedures and requires months of repeated contact with hand therapy for optimal outcomes. The environmental impacts of treatment have not previously been evaluated. A pilot retrospective service evaluation using process mapping and life-cycle assessment of 17 patients undergoing flexor tendon repair was performed using the functional unit of one completed patient pathway cycle, from ED to surgery, to rehabilitation and full recovery. Data were collected retrospectively from electronic patient records, supplier data and emission factor databases. Estimates for carbon dioxide emissions were generated in kgCO₂eq., allowing us to look for specific opportunities for pathway optimisation, in line with the national guidelines. We estimated the carbon footprint of a patient undergoing flexor tendon repair to be approximately 113.2 kgCO₂eq. The rehabilitation phase made the greatest contribution to emissions (59.9 kgCO₂eq., 52.9%) and patient travel was responsible for 79.4% of total emissions (89.9 kgCO₂eq.), followed by the production and transport of equipment (8.5 kgCO₂eq., 7.5%) needed for treatment. The results of this pilot eco-audit identified key emission sources and potential interventions to reduce carbon emissions for this pathway. These include reducing the need for patient travel, which can be achieved by greening hand therapy through increased use of virtual consultations and encouraging the use of mobile phone applications. We also recommend the adoption of circular economy principles by using reusable surgical gowns and drapes, creation of procedure-specific equipment packs, and increased use of wide-awake local anaesthesia, no tourniquet.