DS22 ‘We need to talk’: the effect of departmental discussion of British Society for Dermatological Surgery sustainability guidance on use of absorbable suture material and its environmental impact

Abstract The 2022 British Society for Dermatological Surgery (BSDS) sustainability guidelines recommend considering use of absorbable sutures for surgical wound closure. This is to reduce footfall from reattendance for suture removal, to free the associated clinician and administrative time and to reduce plastic waste. The National Health Service (NHS) accounts for around 4% of England’s greenhouse gas emissions, with travel to general practitioner surgeries making up 5% of NHS emissions. Use of absorbable sutures for wound closure was considered during the COVID-19 pandemic, to minimize in-person attendance for suture removal. Compliance with this aspect of the BSDS sustainability guidance was discussed at our dermatology governance meeting in April 2024, and usage of absorbable sutures appeared to be low, indicating that the prepandemic practice of using mostly nonabsorbable sutures had largely resumed. An audit was undertaken to compare the frequency of use of absorbable suture material in appropriate patients before COVID-19, 2 years postpandemic and after formal discussion of the BSDS sustainability guidance. Surgical notes of 100 consecutive patients requiring skin closure after skin surgery from each of July 2019, July 2023 and July 2024 were reviewed in our dermatology department, and the type of suture material used was documented. Patient notes from 2019 were representative of prepandemic practice, while notes from 2023 reflected postpandemic upkeep and from 2024 represented compliance after discussion of the BSDS guidance at our governance meeting. Of the 100 patient notes assessed from July 2019, July 2023 and July 2024, absorbable sutures were employed for wound closure in 3%, 22% and 84% of patients, respectively. There was an almost fourfold increase in the use of absorbable sutures following discussion at the governance meeting, with only a small increase following the pandemic. Our dermatology department performs approximately 3200 surgical procedures per year requiring suture placement. Since the discussion, 60% more had absorbable sutures placed, resulting in around 2000 patients not having to travel for suture removal, saving an equal amount of nurse appointments, and adding our grain of sand to national efforts to reduce our carbon footprint. While there had been a small increase in the use of absorbable sutures after COVID-19, a major shift occurred only after explicit discussion. This demonstrates the impact of highlighting this aspect of the BSDS guidance, through bringing it to attention in a designated meeting space, away from clinical distractions and with clear explanation of rationale.