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A team of masked surgeons in medical gowns and skull caps performing an operation beneath operating theatre lights

University of Birmingham experts worked with a surgical team at University Hospitals Birmingham NHS Foundation Trust to complete the first documented ‘net zero’ operation in the NHS - with the patient discharged safely and recovering well from a keyhole procedure to remove a bowel cancer.

Performed at Solihull Hospital, the operation introduced several changes to the team’s normal practice. This first net zero operation combines evidence-based approaches and documents using a carbon output calculator developed specifically for this task by experts, led by Dr Dmitri Nepogodiev, at the University of Birmingham.

Mr James Glasbey, a surgeon wearing scrubs and skull cap standing in front of medical monitors and equipment
Sustainable surgery: The first ‘net zero’ operation in the NHS

Operating theatres are resource intensive environments, contributing to 25% of the Trust’s carbon output. We cannot achieve net-zero health systems without making surgery more green, so this is a vital proof of concept step.

Mr Aneel Bhangu, UHB Consultant Surgeon and Senior Lecturer at the University of Birmingham

Changes to normal practice

  • Using reusable gowns, drapes, and scrub caps
  • Giving medications through the veins for general anaesthesia rather than anaesthetic gases, which have a strong greenhouse effect
  • Implementing a plan for minimising electricity use, including heating and lighting
  • Recycling of single-use equipment used in surgery, working with industry partners
  • Recycling of ‘clean’ paper and plastic waste
  • Using individually packed equipment, and only opening items as they were required
  • One consultant surgeon ran to hospital and the other cycled

UHB Consultant Surgeon and Senior Lecturer at the University of Birmingham Mr Aneel Bhangu said: “Operating theatres are resource-intensive environments, contributing to 25% of the Trust’s carbon output. We cannot achieve net-zero health systems without making surgery more green, so this is a vital proof of concept step.

“Ensuring healthcare is environmentally friendly is important to patients and communities. These measures require changes in behaviour and care pathways across complex teams. We now hope to work with colleagues across the UK to create a wider impact across the whole NHS.”

“As a large NHS organisation, we know UHB has a significant carbon footprint, but we are committed to reducing this as much as possible whilst still providing the care and treatment our patients need. I hope this net zero operation is the first of many, not just at UHB but across the NHS.”

Tim Jones, Chief Innovation Officer at UHB

The net zero operation involved all members of the team including the surgeons, anaesthetists, nurses, cleaners, porters, and managers.

Tim Jones, Chief Innovation Officer at UHB, added: “I would like to thank Aneel and his colleagues for their work on delivering the first net-zero operation in the NHS.

“As a large NHS organisation, we know UHB has a significant carbon footprint, but we are committed to reducing this as much as possible whilst still providing the care and treatment our patients need.

“I hope this net zero operation is the first of many, not just at UHB but across the NHS.”

At the end of the operation, the team used the calculator to estimate the reduction in carbon output for the operation compared to the usual output. They calculated that the carbon output was reduced by almost 80%, with the remaining output then offset through a variety of verified carbon offsetting projects, including the planting of trees in the grounds of Solihull Hospital. This brought the total carbon output for the operation to net zero.

Safety and efficiency were maintained for the patient throughout, carried out within a full, day-long operating list, including surgery for three other patients.

The NHS contributes 6% of the UK’s total carbon footprint, and COP26 targets will not be achieved without moving towards a more sustainable future in healthcare. Operating theatres are an important focus – making up as much as 25% of hospitals’ contribution, despite less than 5% of hospital inpatients undergoing surgery.

As the NHS COVID-19 recovery plan for elective surgery is introduced and doctors across the NHS look to increase the volume of elective surgery, measures such as these will ensure that the impact on the planet is kept to a minimum.

Patient advocate and research involvement lead Dr Lesley Booth CBE said: “Reducing the environmental impact of surgery is hugely important to improving health more broadly. We know that climate change and air pollution has wide impacts on health, many of which aren’t measurable until years to come. I would want my operation in a hospital that cares about the environment, showing its commitment to patients and public health.”

Further net zero operations are planned at UHB in the coming weeks.