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Surgeons reaching for medical implements

Surgeons and academics from around the world gathered at the University of Birmingham to consider research to achieve net zero emissions in operating theatres.

The first-of-its-kind Research for Greener Surgery Conference 2023, organised by the NIHR Global Health Research Unit on Global Surgery at the University of Birmingham, saw thought leadership and presentations about how healthcare providers can decarbonise surgery while maintaining the highest standards of patient care.

Launching the conference, Professor Lucy Chappell, Chief Executive Officer of the National Institute for Health and Care Research and Chief Scientific Advisor for the Department of Health and Social Care set out an imperative for an evidence-based approach to net zero surgery and the challenges associated with achieving this goal.

Professor Chappell said:

“It’s a pleasure to be here in Birmingham with teams leading work in the Global Surgery Unit, who have drawn multidisciplinary and diverse teams together on sustainable healthcare from a wide geographical footprint. It is essential that, as a community, we consider how health and care research responds to the global challenge of working towards net zero. We know that climate change is intricately linked with human health, as demonstrated at the recent COP28 conference.

"The Birmingham meeting looked at how we can use research to address reducing the carbon footprint across the health and care system, looking for benefits across health outcomes, sustainability and cost-effectiveness. We can also look at how research delivery is part of that move to more patient-centred, lower carbon healthcare. NIHR is choosing to have a strong portfolio of research in this area and we welcome the leadership shown at this conference."

The conference then heard from members of the Global Surgery Unit about key aspects of their strategy for ‘green surgery’, including developing a thorough model for carbon accounting and the role of behaviour change in helping teams move to more environmentall sustainable practices.

Trial on safety of reusable gowns and drapes


Surgical teams around the world will be taking part in the first trial of its kind, launched at the conference, which will test whether reusable gowns and drapes are just as effective in reducing surgical site infections (SSIs).

The trial called DRAGON, which will take place across more than 130 operating theatres globally and is expected to recruit around 27,000 participants, and will measure the difference in SSIs between reusable and disposable surgical drapes and gowns.

It will be the first-ever surgical trial with a triple endpoint, taking into account the clinical, financial, and environmental impacts of different surgical gowns and drapes

Professor Aneel Bhangu

Aneel Bhangu, Professor of Global Surgery, NIHR Lead Clinician Scientist in the NIHR Global Surgery Unit at the University of Birmingham, who is the chief investigator of the project said:

“The DRAGON trial will provide us with a unique opportunity to consider whether assumptions that are made about the clinical superiority of disposable gowns and drapes hold up. The World Health Organisation makes no recommendation about disposable or reusable drapes and gowns, and there is a significant financial and environmental cost from producing, procuring and destroying millions of tons of clinical gowns each year.

“DRAGON is a global randomised trial (27,000 patients, 134 hospitals) comparing reusable versus single-use theatre drapes and gowns, launching in early 2024. It will be the first-ever surgical trial with a triple endpoint, taking into account the clinical, financial, and environmental impacts of different surgical gowns and drapes.

The GreenSurg UK research team will be hosting a public forum at 6pm on Thursday 18 January 2024 at the Queen Elizabeth Hospital Birmingham, explaining how research aims to make operating theatres more environmentally friendly. The event is open to patients and members of the public.