Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.
The sapheno-femoral junction (SFJ) and the great saphenous vein (GSV) are recognized as one of the main sources of reflux in chronic venous disease. Moreover, reflux time is considered as the main parameter to characterize GSV disease. Despite this, it is well-known in the clinical practice that not all patients with SFJ/GSV reflux are similar, in terms of disease severity and degree. Some other anatomical findings, such as SFJ and GSV diameters, as well as the absence/incompetence of suprasaphenic femoral valve (SFV) might be of interest to better “quantify” the disease severity. The aim of this paper is to describe, through a duplex scan analysis, the relationship between SFJ incompetence, GSV/SFJ diameter and SFV absence/incompetence, to identify if there are patients with “severe” GSV disease and a potential higher recurrence rate after invasive treatments.
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