Faculty Bibliography

BACKGROUND/PURPOSE/OBJECTIVE:e) from EBRT in the U.S., estimate their down-stream impact on human health in terms of disability-adjusted life-years (DALYs) lost, and evaluate the potential reduction in emissions through increased adoption of hypofractionation, using early-stage breast cancer as a model. MATERIALS/METHODS/METHODS:This is a retrospective analysis using life cycle assessment (LCA) methodologies, integrating real-world data on patient transportation and energy use, and simulations of alternative fractionation schedules following previously established breast treatment guidelines. The study included 556,426 patients who received EBRT for nine cancer types (breast, central nervous system, gastrointestinal, genitourinary, gynecological, head and neck, musculoskeletal, skin, and thoracic), as recorded in the National Cancer Database (NCDB) in 2019 and 2020. Of these, 49,909 patients with early-stage breast cancer (stages I-II, node-negative) were modeled for hypofractionation scenarios. RESULTS:e, respectively. Corresponding DALYs lost were 1,040 in 2019 and 863 in 2020. Simulations showed that increasing use of hypofractionation for eligible breast cancer treatments could reduce GHG emissions by up to 64 %. CONCLUSIONS:Establishing baseline U.S. GHG emissions from EBRT offers a foundation for identifying opportunities to mitigate emissions. Investigating clinical practices from an environmental perspective can yield dual benefits: improved quality of care and significant emissions reductions.

INTRODUCTION/UNASSIGNED:Cataract surgery, among the most common procedures worldwide, significantly contributes to climate change through both solid waste and air pollution, highlighting the urgent need for targeted interventions. Implementation faces hurdles including legal constraints and concerns about infection risks and malpractice. METHODS/UNASSIGNED:This article examines federal and state regulatory structures around two key waste reduction strategies: reduction of multidose medications and distribution of partly-used operating room medication to patients post-surgery. RESULTS/UNASSIGNED:We find little-to-no legitimate regulatory barriers to either waste reduction practice. Dispensing and redistributing partly-used medication has been codified in law in some states. Evidence-based reports indicate minimal risks for infection with proper handling. From 1998 until August 2024, according to the Ophthalmic Mutual Insurance Company, there were no reported endophthalmitis lawsuits from using multidose eye drops perioperatively. Malpractice fears also appear to be generally unfounded considering guidelines by various professional organizations identifying these practices as acceptable standards of care and lack of related lawsuits. CONCLUSION/UNASSIGNED:In order to implement evidence-based sustainability interventions, more education and training is needed to ensure clinicians and staff are aware of real and perceived barriers.

BACKGROUND:Healthcare is responsible for 8.5% of greenhouse gas emission in the United States. Physicians are becoming increasingly concerned about the climate crisis, particularly in the field of ophthalmology where there is a growing body of literature related to sustainability. Although emissions of cataracts surgery, one of the most performed surgical procedures in the world, have been quantified, modifications to practice have yet to be made. This study aims to uplift the perspectives of a diverse set of healthcare workers on implementing environmentally sustainable practices in the cataract surgery setting. METHODS:16 semi-structured interviews were conducted with professionals working in various direct patient care or administrative roles at a large health center to gain insight on implementing a variety of sustainability initiatives. We focused on initiatives related to supply reduction, reusable supplies, multi-dosing pharmaceuticals, and health system process and policy shifts. RESULTS:Participants most frequently identified infection prevention and control (IPC) concerns as a primary barrier to implementation. Additionally, the IPC department was most often cited as a key stakeholder in implementation. However, participants from this department did not share these same concerns. Additionally, participants most often cited that these initiatives would be successfully implemented by those providing direct patient care. CONCLUSIONS:Themes generated from the collection of responses underscore a broader discussion of disconnect between policy and practice in healthcare as a barrier to implementation of these initiatives and an opportunity in harnessing clinically led change to implement sustainable practices in a growing healthcare system.

STUDY OBJECTIVE/OBJECTIVE:To quantify and characterize waste generated in robotic gynecologic surgery and assess its environmental impact, with the goal of identifying strategies to reduce waste and improve sustainability. DESIGN/METHODS:Waste audit and life cycle impact assessment of robotic gynecologic surgery. SETTING/METHODS:Single academic institution. PATIENTS/METHODS:Twenty robotic gynecologic surgery cases, including hysterectomies (n = 10), myomectomies (n = 6), and tubal, ovarian, or endometriosis surgeries (n = 4). INTERVENTIONS/METHODS:A detailed waste audit of all surgical waste to categorize materials into municipal solid waste (MSW) and regulated medical waste (RMW), allowing for subsequent life cycle impact assessment. MEASUREMENTS AND MAIN RESULTS/RESULTS:e (SD 0.27) per minute of operative time, with shorter surgeries producing the most emissions per minute. Cotton products contributed up to almost one-third of an impact category despite accounting for 5% of the total waste by weight. CONCLUSION/CONCLUSIONS:Opportunities to reduce the environmental impact of robotic gynecologic surgeries include reorganizing surgical kits to avoid the unnecessary opening of commonly unused items, increasing reprocessing of single-use devices, properly sorting recyclable plastics and paper products, appropriately using RMW streams, considering alternative surgical modalities for less complex cases, and exploring reusable or more environmentally-friendly alternatives to cotton and spunbond-meltblown-spunbond polypropylene products.

In LA County, contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus require 7.3 million gowns annually generating 506 tons of plastic waste and 1.73 million kilograms of carbon dioxide equivalents, which cause the loss of 4.07 disability-adjusted life-years. Unintended consequences of gown use necessitates exploration of infection prevention alternatives.

BACKGROUND AND OBJECTIVE/OBJECTIVE:The health care sector is a significant contributor to greenhouse gas (GHG) emissions, and assessments of the environmental impacts of health services are essential. We aimed to evaluate the environmental impact of a highly common but controversial urology-specific blood test: the prostate-specific antigen (PSA) test. METHODS:e). The secondary outcome was the health impact attributed to the environmental harm of the test. KEY FINDINGS AND LIMITATIONS/UNASSIGNED:e, equivalent to driving 14.5 million miles, with a resulting human health impact of 6.6 disability-adjusted life years annually. This study focused on the PSA test itself, and not on emissions from staff, patient, or sample transportation; building infrastructure; or cleaning. CONCLUSIONS AND CLINICAL IMPLICATIONS/CONCLUSIONS:Although the carbon footprint of a single PSA test is small, the cumulative impact of the estimated total of 30 million PSA tests performed annually in the USA is substantial, especially when considering that a notable proportion of these tests may be performed on men who are unlikely to benefit.

INTRODUCTION/BACKGROUND:There is increasing prevalence of single-use flexible laryngoscopes in Otolaryngology. This study aims to quantify and compare the environmental outcomes of single-use disposable flexible laryngoscopes (SUD-Ls) and reusable flexible laryngoscope (R-Ls). METHODS:-eq) and analyzed using the US EPA's TRACI and SimaPro software. Monte Carlo sensitivity analyses were additionally performed. RESULTS:-eq). Notably 63% of the R-L total GHGs were due to personal protective equipment (PPE) production and disposal used in reprocessing, whereas 79% of SUD-L total GHGs were attributed to scope manufacturing and production. In a break-even analysis, a R-L produces fewer lifespan GHGs than SUD-Ls after 82 uses. CONCLUSION/CONCLUSIONS:Reusable flexible laryngoscopes pose an environmental benefit over SUD-Ls across several impact categories when used in high frequency. SUD-Ls have significant advantages in various situations: low utilization settings, in-patient/ED consults, and urgent need for sterile instrumentation. Providers should assess laryngoscope use frequency, site of use, and available resources to balance the environmental consequences. Further areas of sustainable optimization include reducing disposable PPE used in R-L reprocessing. LEVEL OF EVIDENCE/METHODS:N/A Laryngoscope, 2024.

BACKGROUND:Healthcare is a major contributor to global greenhouse gas emissions. Colorectal cancer (CRC) screening is one of the most widely used healthcare services in the US, indicated for approximately 134 million adults. Recommended screening options include fecal immunochemical tests (FITs) every year, CT colonographies (CTCs) every 5 years, or colonoscopies every 10 years. We compared the environmental impacts of these tests and identified opportunities for impact reduction. METHODS:We conducted a comparative life cycle assessment of three CRC screening strategies at the University of California, San Francisco. We performed on site audits to document the materials and energy used for each screening test. We used the ReCiPe 2016 method to estimate the environmental impacts of these procedures, measured by global warming potential (GWP) and damage to human health. We estimated the 10-year cumulative impacts of each screening strategy using a Markov reward model. We accounted for model uncertainty using hierarchical Monte Carlo simulations. FINDINGS/RESULTS:FIT-based screening had the lowest environmental impacts, with a roughly 20% margin of superiority over colonoscopies, and this finding was robust in sensitivity analyses. Across tests, the biggest cause of environmental harm was car-based transportation of patients and staff. Prioritizing FITs over screening colonoscopies in the US could enhance population health by roughly 5.2 million disability adjusted life years per decade. Transitioning to electric vehicles could reduce the GWP of all screening tests by 15-20%. INTERPRETATION/CONCLUSIONS:Given the similar efficacy and safety of these tests, payors should prioritize FITs for low-risk patients. Government initiatives to decarbonize transportation, incentivize telehealth, and mandate environmental product declarations will help reduce the environmental impacts of healthcare more generally. Our results call for a closer look at resource-intensive preventative health strategies, which could result in more harm than good if applied to a low-risk population. FUNDING/BACKGROUND:NIH, UCSF.

(1) Background: Healthcare is a major contributor to global greenhouse gas (GHG) emissions, especially within the surgical suite. Ophthalmologists play a role, since they frequently perform high-volume procedures, such as cataract surgery. This review aims to summarize the current literature on surgical waste and GHG emissions in ophthalmology and proposes a framework to standardize future studies. (2) Methods: Protocol and reporting methods were based on PRISMA guidelines for scoping reviews. Articles that reported any quantitative measurement of waste or GHGs produced from ophthalmic surgeries were eligible for inclusion. Commentaries, opinion papers, reviews and articles in a non-English language were excluded. (3) Results: A total of 713 articles were reviewed, with 10 articles found to meet inclusion criteria. Six studies produced level 3 evidence, two level 4 evidence, and one level 5 evidence. According to studies, most of the GHGs came from procurement of surgical materials, followed by travel emissions and building energy. (4) Conclusions: Research on waste and GHGs produced in ophthalmic surgery is limited, and existing studies utilize varied approaches to quantify this waste. We propose a standardized waste-lifecycle framework for researchers to organize future research. Such standardization will help in comparing studies and may uncover more opportunities to implement impactful waste reduction strategies in ophthalmology.