Neurosurgical Theatres’ Carbon Net Efficiency: A Service Improvement Project Conducted via the Oxford Cranioplasty Pathway

Background: The research question explored in this study revolves around the quantitative evaluation of the carbon footprint of cranioplasty surgery, a neurosurgical intervention meant to reconstruct skull defects. Methods: Following a calculation of the emissions pertaining to Scope 1 to 3 of the Greenhouse Gas (GHG) Protocol, the authors engaged with various stakeholders to identify possible interventions meant to drive the carbon efficiency of a cranioplasty pathway. The service improvement project (SIP) that ensued was aimed at reducing the volume and weight of the packaging materials for cranioplasty shipping boxes, and decreasing the paper consumption relative to the preparation of user manuals without compromising patients’ safety. Results: Our analysis indicates a cumulative carbon footprint of 104.35 kg CO2e for a single unilateral cranioplasty operation, where packaging corresponds to 6.4% of Scope 3 emissions and 1.41% of its total emissions. Of note, our SIP led to an overall 76.53% decrease in the number of emissions generated by the packaging equivalent required for a unilateral titanium implant. Conclusions: This study demonstrates the effectiveness of a partnership between public institutions and medtech companies in driving carbon net efficiency of a cranioplasty pathway, and we suggest that such approach is scalable to other surgical specialties.