SRS25 - Sustainability in hand trauma surgery: an eco-audit of the flexor tendon laceration repair pathway

Abstract Background Hand trauma accounts for nearly one third of Emergency Department (ED) attendances in the United Kingdom (UK). Flexor tendon repair is one of the most commonly performed Plastic Surgery procedures requiring months of repeat contact with hand therapy for optimal outcomes, the environmental impacts of which have not previously been evaluated. Methods A retrospective study of 17 patients undergoing flexor tendon repair. Process mapping and life-cycle analyses of the patient pathway, from ED to surgery, to rehabilitation and full recovery, was performed. Estimates for carbon dioxide emissions were generated in kgCO2eq. allowing identification for specific opportunities for pathway optimization, in line with national guidelines. Race and ethnicity were not reported in this study. Results This study estimated the carbon footprint of a patient undergoing flexor tendon repair to be approximately 113.2 kgCO2eq. The rehabilitation phase made the greatest contribution to emissions (59.85 kgCO2eq., 52.9%) and patient travel was responsible for a staggering 79.42% of total emissions (89.88 kgCO2eq.), followed by the production and transport of equipment (8.52 kgCO2eq., 7.53%) needed for treatment. Conclusions To reduce carbon emissions, reducing the need for patient travel was suggested. This can be achieved by greening hand therapy through increased use of virtual consultations and encouraging the use of mobile phone applications. Adoption of circular economy principles through the use of reusable surgical gowns and drapes, creation of procedure-specific equipment packs, and increased use of wide-awake local anaesthesia, no tourniquet (WALANT) was also recommended.