Potential Carbon Savings with Day-case Compared to Inpatient Transurethral Resection of Bladder Tumour Surgery in England: A Retrospective Observational Study Using Administrative Data

Phull, Manraj; Begum, Hasina; John, Joseph B; Hove, Maria van; McGrath, John; O’Flynn, Kieran; Briggs, Tim; Gray, William K.

doi:10.1016/j.euros.2023.03.007

Cited by 11 publications

(3 citation statements)

References 16 publications

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“…This indicates that, amongst those patients admitted to hospital, there might be an opportunity to decrease resource utilization by decreasing the LOS. Alongside avoiding hospital admission altogether, minimizing the LOS would reduce inpatient bed pressures and also lower the carbon footprint of BOO surgery pathways, both of which are important priorities [3,17,18].…”

Section: Discussionmentioning

confidence: 99%

Trends in day‐case bladder outflow obstruction surgery: a study using Hospital Episode Statistics

John,

Gray,

O'Flynn

et al. 2023

BJU International

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ObjectivesTo describe the contemporary evolution of day‐case bladder outflow obstruction (BOO) surgery in England and to profile day‐case BOO surgery practices across England in terms of the types of operation performed and their safety profiles.Materials and MethodsThis was a retrospective observational analysis of Hospital Episode Statistics and UK Office for National Statistics data. All 111 043 recorded operations across 117 hospital trusts over 66 months, from 1 January 2017 to 30 June 2022, were obtained. Operations were identified as one of: transurethral resection of prostate (TURP); laser ablation or enucleation; vapour therapy; prostatic urethral lift (PUL); or bladder neck incision. Monthly day‐case rate trends were plotted across the study period. Descriptive data, day‐case rates and 30‐day hospital readmissions were analysed for each operation type. Multilevel regression modelling with mixed effects was performed to determine whether day‐case surgery was associated with higher 30‐day hospital readmissions.ResultsDay‐case patients were younger, with fewer comorbidities. Time series analysis showed a linear day‐case rate increase from 8.3% (January 2017) to 21.0% (June 2022). Day‐case rates improved for 92/117 trusts in 2021/2022 compared with 2017. Three of the six trusts with the highest day‐case rates performed predominantly day‐case TURP, and the other three laser surgery. Nationally, PUL and vapour surgery had the highest day‐case rates (80.9% and 38.1%). Most inpatient operations were TURP. Multilevel regression modelling found reduced odds of 30‐day readmission after day‐case BOO surgery (all operations pooled), no difference for day‐case vs inpatient TURP, and reduced odds following day‐case LASER operations.ConclusionsThe day‐case rates for BOO surgery have linearly increased. Minimally invasive surgical technologies are commonly performed as day cases, whereas high day‐case rates for TURP and for laser ablation operations are seen in a minority of hospitals. Day‐case pathways to treat BOO can be safely developed irrespective of operative modality.

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Section: Discussionmentioning

confidence: 99%

Trends in day‐case bladder outflow obstruction surgery: a study using Hospital Episode Statistics

John,

Gray,

O'Flynn

et al. 2023

BJU International

Self Cite

View full text Add to dashboard Cite

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“…There is substantial unwarranted variation in day‐case rates across NHS hospital Trusts in England, despite evidence that day‐case surgery is safe for carefully selected patients [15–18]. Recent modelling performed by the GIRFT programme and Greener NHS found that progressive increases in the rates of day‐case surgery performed for transurethral resection of bladder tumour (TURBT) surgery has saved 20.9 million kgCO 2 e over 9 years (2013/2014 to 2021/2022), and further adoption of day‐case surgery could reduce carbon emissions by a further 217,599 kgCO 2 e (based on 2021/2022 data [19]). Greenhouse gas emissions have decreased due to the avoidance of unnecessary inpatient hospital admissions after surgery, with no associated increase in the rates of hospital readmission for day‐case patients.…”

Section: Day‐case Surgerymentioning

confidence: 99%

“…More broadly, energy sources across the NHS will require decarbonisation. Alongside innovation and changes in practice towards lower carbon models of care, increasing adherence to best practice guidelines, where the carbon footprint of practice has been reviewed, has the potential to carry significant carbon savings [19]. As such, continuation of deep dives, audits and reviews of practice are needed to support, publicise and roll out innovative good practice and to reduce instances of high carbon footprint and inefficient practice.…”

Section: Delivering a Patient‐centred Servicementioning

confidence: 99%

Unwarranted variation and the goal of net zero for the NHS in England: exploring the link between efficiency working, patient outcomes and carbon footprint

van Hove,

John,

Ojelade

et al. 2024

Anaesthesia

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SummaryIn 2020 the NHS in England set a target of reaching net zero carbon emissions by 2040. Progress has already been made towards this goal, with substantial reductions in the use of environmentally harmful anaesthetic gases, such as desflurane, in recent years. Where an effective replacement already exists, changing practice to use low carbon alternatives is relatively easy to achieve, but much greater challenges lie ahead. The Getting It Right First Time (GIRFT) programme is a clinically‐led, data‐driven clinical improvement initiative with a focus on reducing unwarranted variation in clinical practice and patient outcomes. Reducing unwarranted variation can improve patient care and service efficiency, and can also support the drive to net zero. In this article we set out what the GIRFT programme is doing to support sustainable healthcare in England, why it is uniquely positioned to support this goal and what the future challenges, barriers, enablers and opportunities are likely to be in the drive to net zero.

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Environmental impact of current endoscopic technology in urological procedures: a systematic review on reusable vs. disposable scopes

Peyrottes,

Long-Depaquit,

Pradère

et al. 2024

World J Urol

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Potential Carbon Savings with Day-case Compared to Inpatient Transurethral Resection of Bladder Tumour Surgery in England: A Retrospective Observational Study Using Administrative Data

Cited by 11 publications

References 16 publications

Trends in day‐case bladder outflow obstruction surgery: a study using Hospital Episode Statistics

Trends in day‐case bladder outflow obstruction surgery: a study using Hospital Episode Statistics

Unwarranted variation and the goal of net zero for the NHS in England: exploring the link between efficiency working, patient outcomes and carbon footprint

Environmental impact of current endoscopic technology in urological procedures: a systematic review on reusable vs. disposable scopes

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