Assessing the Environmental Carbon Footprint of Spinal versus General Anesthesia in Single-Level Transforaminal Lumbar Interbody Fusions

Wang, Andy; Ahsan, Tameem; Kosarchuk, Jacob; Liu, Penny; Riesenburger, Ron I.; Kryzanski, James

doi:10.1016/j.wneu.2022.03.095

Cited by 13 publications

(22 citation statements)

References 18 publications

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“…Their findings differed from another study performed in the US that found that the median CO 2 e emissions of general anaesthesia was significantly higher than spinal anaesthesia for single-level transforaminal lumbar interbody fusions (TLIF) [86]. This study performed a partial LCA using a 'cradle-to-gate' assessment, a method that only includes the carbon footprint of a product from the cradle to the moment that it is sold or received by the consumer ('gate').…”

Section: Plos Onecontrasting

confidence: 79%

“…Eleven (46%) of the 24 research studies used a life cycle assessment (LCA) or carbon footprinting methodology to measure the environmental impact of health care or health support services in the fields of orthopaedics (n = 9) [ 83 – 86 , 91 , 95 , 97 , 101 , 103 , 104 ], and medical aid manufacturing (n = 1) [ 105 ].…”

Section: Resultsmentioning

confidence: 99%

“…Included papers were published from 1994 to 2022, with most published since 2019 (n = 36, 73%). There were 24 original research papers, nine from the United States [83][84][85][86][87][88][89][90][91], three from Canada [92][93][94], two each from Ireland [95,96], Sweden [97,98] and the United Kingdom [99,100], and one each from Australia [101], Denmark [102], Germany [103], Italy [104], Serbia [105], and South Korea [106].…”

Section: Overview Of Included Publicationsmentioning

confidence: 99%

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The environmental impact of health care for musculoskeletal conditions: A scoping review

et al. 2022

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Background Health care has significant environmental impact. We performed a scoping review to map what is known about the environmental impact of health care for musculoskeletal conditions. Methods We included published papers of any design that measured or discussed environmental impact of health care or health support services for any musculoskeletal condition in terms of climate change or global warming (e.g., greenhouse gas emissions it produces). We searched MEDLINE and Embase from inception to 2 May 2022 using keywords for environmental health and musculoskeletal conditions, and performed keyword searches using Google and Google Scholar. Two independent reviewers screened studies. One author independently charted data, verified by a second author. A narrative synthesis was performed. Results Of 12,302 publications screened and 73 identified from other searches, 122 full-text articles were assessed for eligibility, and 49 were included (published 1994 to 2022). Of 24 original research studies, 11 measured environmental impact relating to climate change in orthopaedics (n = 10), and medical aids for the knee (n = 1), one measured energy expenditure of laminar versus turbulent airflow ventilation systems in operating rooms during simulated hip replacements and 12 measured waste associated with orthopaedic surgery but did not relate waste to greenhouse gas emissions or environmental effects. Twenty-one editorials described a need to reduce environmental impact of orthopaedic surgery (n = 9), physiotherapy (n = 9), podiatry (n = 2) or occupational therapy (n = 1). Four narrative reviews discussed sustainability relating to hand surgery (n = 2), orthopaedic surgery (n = 1) and orthopaedic implants (n = 1). Conclusion Despite an established link between health care and greenhouse gas emissions we found limited empirical data estimating the impact of musculoskeletal health care on the environment. These data are needed to determine whether actions to lower the carbon footprint of musculoskeletal health care should be a priority and to identify those aspects of care that should be prioritised.

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Section: Plos Onecontrasting

confidence: 79%

Section: Resultsmentioning

confidence: 99%

Section: Overview Of Included Publicationsmentioning

confidence: 99%

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The environmental impact of health care for musculoskeletal conditions: A scoping review

et al. 2022

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“…Most assessed clinically relevant (pain, opioid-consumption, time to ambulation, urinary retention) and/or healthcare system relevant outcomes (length of PACU and hospital stay) rather than patient-centered outcomes (quality of recovery, appropriate patient selection). One study assessed the environmental impact of neuraxial anesthesia and concluded that regional techniques lower the carbon footprint compared with general anesthesia [20 ▪ ]. Overall, this body of evidence suggests that neuraxial anesthesia is at least equivalent to general anesthesia for most outcomes measured and superior to general anesthesia for several others, including postoperative urinary retention, operative time, early pain scores, opioid consumption and time to ambulation.…”

Section: Retrospective Studiesmentioning

confidence: 99%

Spine surgery under neuraxial vs. general anesthesia: the current state of comparative outcomes research

Amoroso

Hughes

Soffin

2023

Current Opinion in Anaesthesiology

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Purpose of review The impact of primary anesthetic technique on outcomes after spine surgery is controversial. Given frequent calls for well designed prospective comparative studies of neuraxial anesthesia vs. general anesthesia and recent reports of ‘awake spine surgery’ successes in the surgical literature, an updated evidence review is indicated. Recent findings Systematic reviews, population-based and retrospective cohort studies suggest few significant differences in important complications or global recovery between anesthetic techniques. On the basis of overall low-to-moderate quality evidence, neuraxial anesthesia is associated with statistically significant benefits for several individual outcomes compared with general anesthesia, including improved intraoperative hemodynamic stability, less postoperative nausea and vomiting, lower early pain scores and shorter length of hospital stay. There are ongoing calls for well designed, adequately powered prospective studies. Summary Our understanding of the risks, benefits and comparative outcomes between neuraxial anesthesia and general anesthesia for spine surgery is evolving. Although the results derived from this body of literature suggest specific benefits of neuraxial anesthesia, further research is required before widespread recommendations for either technique can be made. Until then, both neuraxial anesthesia and general anesthesia are reasonable choices for lumbar spine surgery of short duration, in appropriately selected patients.

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“…Laminectomies — both cervical and lumbar — are common treatments for compressive spinal pathology [1] . With over 450,000 laminectomies performed each year at an average 30-day total cost of 70,000 USD, this procedure is a significant financial burden for the healthcare system [ 2 , 3 ]. While this treatment provides clinically significant neurological symptom improvement, complications and risks are present yet not often reported [4] .…”

Section: Introductionmentioning

confidence: 99%

A cross-sectional analysis of harms reporting in systematic reviews evaluating laminectomy

Howard

Clark

Garrett

et al. 2023

North American Spine Society Journal (NASSJ)

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Assessing the Environmental Carbon Footprint of Spinal versus General Anesthesia in Single-Level Transforaminal Lumbar Interbody Fusions

Cited by 13 publications

References 18 publications

The environmental impact of health care for musculoskeletal conditions: A scoping review

The environmental impact of health care for musculoskeletal conditions: A scoping review

Spine surgery under neuraxial vs. general anesthesia: the current state of comparative outcomes research

A cross-sectional analysis of harms reporting in systematic reviews evaluating laminectomy

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