Seven everyday changes could transform surgery’s environmental impact

The Birmingham-led National Institute for Health and Care Research (NIHR) Global Health Research Unit on Global Surgery has created the Greener Anaesthesia and Perioperative Care (GAP-PACK) guide to improve the sustainability of perioperative care globally.

The GAP-PACK guide recommends actionable changes that can be made that embeds sustainability into perioperative care, such as using local or regional anaesthesia (where appropriate) over general anaesthesia, choosing reusable over disposable equipment, and repairing faulty equipment over throwing it away.

In partnership with the World Health Organisation, as well as professional bodies for anaesthesia (National Institute of Academic Anaesthesia, Association of Anaesthetists GB & NI, and World Federation of Societies of Anaesthesiologists), the aim of the guide is to provide clear, practical actions to help hospital operating theatres reduce waste and environmental impact, without compromising patient safety or care.

Why this matters

Operating theatres use large amounts of energy, equipment, drugs, and single‑use plastics. Much of this creates unnecessary waste and cost. Importantly, many sustainable practices also:

• Improve patient recovery and comfort
• Reduce avoidable risks and complications
• Save time and money
• Increase staff efficiency and reliability of equipment

Patients also increasingly expect healthcare to be environmentally responsible, as long as safety is not reduced.

About GAP-PACK

Over 1900 healthcare professionals from over 70 countries (including low-resource settings) had input via a large global prioritisation exercise, with each action being ranked against three criteria:

• Feasibility
• Acceptability
• Affordability

The seven that were chosen scored highly across all three criteria, which highlighted their readiness for immediate implementation.

The seven actions laid out in the GAP-PACK are as follows:

1. Use local or regional anaesthesia where appropriate
2. Choose reusable equipment instead of disposable items
3. “Don’t open it unless you need it”
4. Avoid unnecessary anaesthetic interventions
5. Maintain and repair equipment rather than throw it away
6. Power down operating theatres when not in use
7. Improve waste segregation and recycling

Rather than calling for new technology or major investment, the guide shows how small, considered changes to everyday practice can make operating theatres safer, more efficient, and greener.

James Glasbey, Assistant Professor and Perioperative Care Lead for the NIHR Global Group on Environmentally Sustainable Operating Theatres, said “The perioperative care community, both in the UK and worldwide, wants to take action against climate change but it's not always clear where to begin. GAP-PACK has taken 'low hanging fruit' which can be immediately implemented in any operating theatre, and given clinical teams the tools required to make a change."

Access the full GAP-PACK guide via this survey.