https://orcid.org/0000-0002-8742-0205
Figures
Abstract
Background
Health care has significant environmental impact. We performed a scoping review to map what is known about the environmental impact of health care for musculoskeletal conditions.
Methods
We included published papers of any design that measured or discussed environmental impact of health care or health support services for any musculoskeletal condition in terms of climate change or global warming (e.g., greenhouse gas emissions it produces). We searched MEDLINE and Embase from inception to 2 May 2022 using keywords for environmental health and musculoskeletal conditions, and performed keyword searches using Google and Google Scholar. Two independent reviewers screened studies. One author independently charted data, verified by a second author. A narrative synthesis was performed.
Results
Of 12,302 publications screened and 73 identified from other searches, 122 full-text articles were assessed for eligibility, and 49 were included (published 1994 to 2022). Of 24 original research studies, 11 measured environmental impact relating to climate change in orthopaedics (n = 10), and medical aids for the knee (n = 1), one measured energy expenditure of laminar versus turbulent airflow ventilation systems in operating rooms during simulated hip replacements and 12 measured waste associated with orthopaedic surgery but did not relate waste to greenhouse gas emissions or environmental effects. Twenty-one editorials described a need to reduce environmental impact of orthopaedic surgery (n = 9), physiotherapy (n = 9), podiatry (n = 2) or occupational therapy (n = 1). Four narrative reviews discussed sustainability relating to hand surgery (n = 2), orthopaedic surgery (n = 1) and orthopaedic implants (n = 1).
Conclusion
Despite an established link between health care and greenhouse gas emissions we found limited empirical data estimating the impact of musculoskeletal health care on the environment. These data are needed to determine whether actions to lower the carbon footprint of musculoskeletal health care should be a priority and to identify those aspects of care that should be prioritised.
Citation: McKenzie BJ, Haas R, Ferreira GE, Maher CG, Buchbinder R (2022) The environmental impact of health care for musculoskeletal conditions: A scoping review. PLoS ONE 17(11): e0276685. https://doi.org/10.1371/journal.pone.0276685
Editor: Matthew John Meyer, University of Virginia, UNITED STATES
Received: January 27, 2022; Accepted: October 12, 2022; Published: November 28, 2022
Copyright: © 2022 McKenzie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the manuscript and its Supporting Information files.
Funding: BM is supported by a PhD scholarship from the Chiropractic Australia Research Foundation and a top-up scholarship from the National Health and Medical Research Council (NHMRC) Australia & New Zealand Low Back Pain Research Network Centre of Research Excellence (ANZBACK CRE) (1171459). GF is supported by an NHMRC Emerging Leadership Fellowship (APP2009808). CM and RB are supported by NHMRC Leadership Fellowships. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. There was no additional external funding received for this study. Funder websites: https://chiropracticaustralia.org.au/research-foundation/, https://anzback.org/, https://www.nhmrc.gov.au/.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Climate change is an existential crisis [1]. There is a need to understand the key contributors to climate change to minimise their impacts. Health care results in significant direct and indirect greenhouse gas emissions, commonly termed the ‘carbon footprint’. It is responsible for between one to five percent of the total global environmental impacts [2], although the proportion of overall greenhouse emissions due to health care is greater in some countries such as the United States (8.5%) [3], and Australia (7%) [4]. The UK, whose health care greenhouse emissions is responsible for approximately 4% of the UK’s footprint, is leading the world in striving for carbon neutral health care by 2040 [5].
The largest contributors to the carbon footprint of health care are generated as part of hospital stays, surgery, pharmaceutical manufacturing and imaging [4, 6]. Recent carbon footprint estimates suggest the majority of health care related greenhouse emissions are produced from energy use and the health care supply chain such as manufacturing medical equipment and materials, transport, agriculture and waste disposal [7]. Yet awareness of the carbon footprint generated by different aspects of health care is not yet well appreciated among many health care providers or the general public, delaying efforts to identify and reduce it [8].
Approximately one third of health care is estimated to be of low value or ‘wasted’ [9–11]. For example, there is a large body of evidence attesting to widespread low-value health care practices for common musculoskeletal conditions such as osteoarthritis [12], low back pain [13], hip and knee pain [12], shoulder pain [14–16] and sports injuries [17]. Directing efforts towards eliminating these aspects of care would have the dual benefit of reducing harms associated with unnecessary care, and avoiding their harmful effects on the environment.
While the environmental impact of health care in some fields of medicine has been investigated, including treatment of patients with septic shock in intensive care [18], cataract surgery [19] and geriatric medicine [20], there is a paucity of evidence outlining environmental impacts of other types of care. The aim of this scoping review was to map what is known about the environmental impact of health care for musculoskeletal conditions.
Methods
We reported this scoping review in accordance with the recommendations of the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR; [21], see S1 Data).
Selection criteria and study selection
We included published papers that measured or explicitly discussed the environmental impact of health care or health support services for any musculoskeletal condition. This could include the impacts of the care (e.g. imaging, hospital visits, surgery, prescription medication) on indices of climate change or global warming such as the amount and type of greenhouse gas it produces [22]. All publication designs were eligible for inclusion, including original research, reviews, or commentaries. We did not impose any date or language restrictions.
Search strategy
We searched electronic databases of MEDLINE and Embase (via Ovid) from inception to 2 May 2022. Our search strategy consisted of combining two concepts: environmental health and musculoskeletal conditions. Internet searches were also performed using Google and Google Scholar between 2 May and 12 May 2022 within the Google Chrome browser. The internet search engines were chosen to ensure a wide range of publications across multiple musculoskeletal disciplines, and combined environmental keywords ‘life cycle assessment’, ‘sustainability’, ‘environmental sustainability’, ‘environmental impact’ and ‘carbon footprint’ with terms of ‘hand’, ‘wrist’, ‘elbow’, ‘shoulder’, ‘foot’, ‘ankle’, ‘knee’, ‘hip’, ‘spine’ and ‘spinal’. We also used various combinations of the following keywords: ‘surgery’, ‘surgical’, ‘surgical implant’, ‘orthopaedic surgery’, ‘joint arthroplasty’, ‘joint arthroscopy’, ‘joint replacement’, ‘telemedicine’ and ‘telehealth’. We considered the first 50 Google and Google Scholar results from each set of keywords. The full search strategy is presented in see S2 Data. We also hand searched reference lists of included publications.
All records generated from electronic databases were exported to Covidence (Veritas Health Innovation, Melbourne, Australia) for duplicate removal and screening [23]. Two authors (BM and either RH, GF, CM or RB) independently assessed each title and abstract and then independently screened the full texts of potentially eligible publications to identify those eligible for inclusion. Google and Google Scholar records were independently assessed by one author (BM). Potentially eligible publications were downloaded as full texts and screened by two authors (BM and either RH, GF, CM or RB). Publications not written in English were translated with Google Translate [24]. Conflicts were resolved through discussion. Publications relating to the same primary publication were considered together and counted only once.
Data charting and analysis
For each original research publication, one author (BM) independently charted author/s, year, country, setting, timing of study, study design, topic, aim/s and methods, results and conclusion. Data from editorial publications and narrative reviews were independently charted by one author (BM) for author/s, year, country of author/s, topic, focus and conclusions. Another author (RH, GF or RB) independently verified all data extraction. A narrative synthesis of the papers is presented.
Results
Of 12,302 publications retrieved and screened from electronic databases and 73 publications that were identified and screened using Google, Google Scholar and hand searches of citations, 122 full-text articles were assessed for eligibility and 48 were excluded (Fig 1). Reasons for exclusion were wrong topic (n = 25) [25–49], wrong setting (n = 3) [50–52], wrong population (n = 1) [53], unclear population (n = 4) [54–57], and duplicates (n = 15) (see S1 Table and S2 Data for more detail). Nine conference abstract publications were classified as awaiting assessment [58–66] (see S2 Table). Sixteen reports of included publications were collated with an associated primary report and counted as a single unit to prevent duplication of the same record [67–82] (see Tables 1 and S3). Forty-nine primary publications were included in this review [83–131].
Overview of included publications
The characteristics and findings of included publications are presented in Table 1 for original research publications and as supplementary materials for included editorials and reviews (see S3 and S4 Tables). Included papers were published from 1994 to 2022, with most published since 2019 (n = 36, 73%).
There were 24 original research papers, nine from the United States [83–91], three from Canada [92–94], two each from Ireland [95, 96], Sweden [97, 98] and the United Kingdom [99, 100], and one each from Australia [101], Denmark [102], Germany [103], Italy [104], Serbia [105], and South Korea [106].
There were 21 editorials with authors from 13 countries; Australia [107–111], Brazil [109], Canada [112], Germany [109], Greece [109], India [113, 114], New Zealand [109, 115], Norway [109, 111, 114, 116], Pakistan [109], Sweden [109, 117, 118], Switzerland [109, 119], United Kingdom [100, 109, 117, 120–122] and United States [109, 116, 123–127]. There were four narrative reviews, two from the United States [128, 129] and one each from India [130] and the United Kingdom [131]. Thirty-six (73%) included publications were related to orthopaedic surgery [83–104, 106, 117, 120–131].
Original research studies.
Eleven (46%) of the 24 research studies used a life cycle assessment (LCA) or carbon footprinting methodology to measure the environmental impact of health care or health support services in the fields of orthopaedics (n = 9) [83–86, 91, 95, 97, 101, 103, 104], and medical aid manufacturing (n = 1) [105].
Two LCA studies investigated the environmental impact of manufacturing a titanium implant for a knee [95] or hip [104] replacement. Both concluded that additive manufacturing of a prosthesis (building it one layer at a time) is more environmentally sustainable than creating complex geometric shapes using conventional methods (subtractive manufacturing or forging, milling, machining from a solid block of material until the final product is produced). One study reported that additive manufacturing of a titanium knee produced 68% less carbon emissions compared with conventional methods [95].
Two LCA studies investigated the carbon footprint of telehealth or telemedicine services versus usual care. One compared the carbon footprint of patient evaluations before and after implementing a model of care that included telehealth for patients undergoing elective spinal surgery [91], and the other compared the carbon footprint of telemedicine versus in-person consultations for hand surgery rehabilitation [97]. Both studies reported significant reductions in carbon emissions when telehealth or telemedicine was used.
Three LCA studies explored the carbon footprint of various hand surgeries [83–85]. One compared the carbon footprint of open to endoscopic carpal tunnel release surgery [85]. This study reported a significantly larger carbon footprint for endoscopic surgery due to higher energy requirements from sterilising surgical instruments and longer operating times. Another study quantified the carbon footprint of surgical waste from different types of hand surgeries and concluded it could be reduced by reducing the number of surgical items in the operating room and better sorting of waste for appropriate disposal [84]. The third study estimated the carbon footprint of three hand surgeries (carpal tunnel release, open reduction and internal fixation of distal radius fracture or primary flexor tendon repair) based upon the practices of 35 surgeons [83]. They found significant differences in operating room waste for the same surgery dependent upon the individual surgeon’s practices.
One LCA from Germany compared the environmental impact of disposable versus reusable instrument sets for lumbar spine fusion surgery [103]. It found that disposable sets had 45 to 85% less environmental impact largely attributable to the high energy consumption of steam sterilisation for reusable sets.
One LCA was an engineering-based case study that included a multi-criteria decision-making approach to compare the environmental impact of three knee supports manufactured from different materials [105]. It concluded that these methods are useful to identify and optimise new eco-friendly products.
One LCA study quantified the average carbon dioxide equivalent (CO2e) emissions of general, spinal and combination (general and spinal) anaesthesia used for knee replacements at a hospital in Melbourne, Australia using a ‘cradle to grave’ assessment [101]. This method measures the carbon footprint of a product from the resource extraction phase (‘cradle’) to its disposal (‘grave’). As well as the anaesthesia, it included single-use items (e.g., plastics, glass, cotton etc.) and waste disposal. McGain et al. (2021) reported similar CO2e emissions for general, spinal, and combination anaesthesia when the parameters for the inhaled anaesthetic, including use of sevoflurane as the inhaled anaesthetic, were the same in those that received either general anaesthesia alone or a combination of general and spinal anaesthesia [101].
Their findings differed from another study performed in the US that found that the median CO2e emissions of general anaesthesia was significantly higher than spinal anaesthesia for single-level transforaminal lumbar interbody fusions (TLIF) [86]. This study performed a partial LCA using a ‘cradle-to-gate’ assessment, a method that only includes the carbon footprint of a product from the cradle to the moment that it is sold or received by the consumer (‘gate’). Therefore, some large sources of CO2e emissions (e.g., single-use plastics, electricity for patient air warmer) were not included. Another point of difference was that the Australian study calculated CO2e emissions based on an electricity mix derived from 75% brown coal which has double the CO2e emissions than electricity produced in the United States [101].
One Danish simulation study measured the energy consumption of differing types of ventilation (ventilation system fans and warming/cooling coils) in operating theatres during mock total hip replacements [102]. They reported that reducing fresh air influx for laminar airflow systems by 50% led to significantly lower energy consumption without resulting in an unacceptable increase in bacterial counts.
The remaining 12 research studies measured waste associated with orthopaedic surgery [87–90, 92–94, 96, 98–100, 106]. One study estimated that average dry weight waste, of which textiles (e.g. bandages, disposable sheets) accounted for over half, could be reduced from 5.7 to 4.5 kg per cemented hip replacement by switching to customised operating kits containing less consumable materials, packaging and products [98].
A further nine hospital waste audits quantified the weight of waste of 205 orthopaedic operations, predominantly joint replacements [88, 89, 93, 94, 99, 100, 106], but also hip arthroscopies [92], facet joint injections [100] and open reduction and internal fixation (ORIF) for malleolus ankle fracture [96]. Three waste audits reported the volume of surgical waste and extrapolated data to estimate annual landfill from knee replacement surgeries in Canada [94], as well as the potential reduction of waste or CO2 emissions from recycling programs [99] and waste segregation [106]. Non-recyclable waste was the largest waste stream for most orthopaedic operations [88, 89, 92–94, 96, 99, 100, 106].
Most waste audits recommended strategies to reduce waste in orthopaedic surgery including implementing recycling programs [88, 92–94, 96, 99, 100, 106], segregating waste [88, 92–94, 96, 99, 100, 106], educating hospital staff to correctly dispose of recyclable waste [88, 93, 100], documenting ‘green outcomes’ from surgical procedures to encourage green health care practices [92], commencing surplus recovery programs [92, 94], reducing excessive packaging of surgical materials [94, 96, 98, 106], moving to reusable surgical linens [94], providing surgeons with a selection of operating kits that can be re-sterilised between procedures [96], and adopting new procurement routines [98, 100].
One study found that combining a ‘minimal custom’ surgery pack with local anaesthesia rather than a standard surgery pack with sedation and local anaesthesia reduced average surgical waste by 13% for minor hand surgery [90]. The final study redesigned the operating set to include 23 rather than 35 instruments for hand surgery and implemented a waste recycling program that resulted in a 20 to 51% increase in monthly recycling rates across three hospital sites [87].
Editorials.
Twenty-one editorial papers described a need to reduce environmental impact of orthopaedic surgery (n = 9) and focussed on disciplines responsible for managing musculoskeletal conditions (n = 12). Of those relating to orthopaedic surgery; three discussed a need for orthopaedic surgery to adopt sustainable practices [121, 125, 126]; two discussed strategies for reducing the environmental impact of hand surgery [120, 122]; one focused on the benefits of regional anaesthesia in place of inhaled volatile anaesthetic gases [124]; one discussed the reuse of undamaged surgical screws or prostheses opened but not used during surgery [123]; one discussed recycling of metal implants posthumously [117]; and one reported the total weight of waste from 1,099 unspecified hand surgeries, but no methods were reported [127]. Of those discipline-specific editorials, nine discussed the environmental impact of physiotherapy and the role of the profession in reducing it [109–111, 113–116, 118, 119], two discussed how podiatrists can engage with the community to drive sustainable practice [107, 108], and one outlined strategies for occupational therapists to approach climate change [112].
Narrative reviews.
Two narrative reviews summarised environmentally sustainable changes that can be implemented for hand surgery [128, 131]. One summarised ‘Lean and Green’ initiatives that aim to reduce waste-energy consumption, improve sterilisation techniques and reprocess single-use devices [128], and the other summarised changes to reduce the carbon footprint of hand surgery using a ‘Reduce, Reuse, Recycle, Research, Rethink and Culture’ framework [131]. Both reviews reported financial benefits from implementing environmentally sustainable hand surgery practices. There were four additional papers relating to these publications [87, 90, 94, 127] (see Tables 1 and S3).
One narrative review on environmental sustainability in orthopaedic surgery, that identified all seven relevant studies that we included, highlighted a need for high-quality research on best practices for orthopaedic surgery to reduce its carbon footprint [129] (see Table 1). The remaining narrative review explored bioresorbable orthopaedic implants as a sustainable alternative to traditional permanent implants for some orthopaedic surgeries [130].
Discussion
Our scoping review identified 49 publications focused on the environmental impacts of health care for musculoskeletal conditions. Most papers were published within the last three years and almost half were editorials, likely reflecting an increasing interest in the topic. Almost three-quarters were related to orthopaedic surgery which is consistent within other health fields that have recognised surgery as a large contributor of greenhouse gas emissions [134–136]. Of the 24 included original research studies less than half directly measured the environmental impact relating to climate change for any aspect of musculoskeletal health care and none quantified the carbon footprint of well-recognised contributors of greenhouse gas emissions such as hospital stays, pharmaceuticals and imaging [4, 55].
Our review identified some promising strategies for reducing the environmental impact of musculoskeletal health care including use of additive rather than subtractive manufacturing of orthopaedic components, greater use of telehealth, and reducing fresh air influx for laminar airflow systems in operating theatres, that warrant further investigation. The finding that open carpal tunnel release has a lower carbon footprint compared to endoscopic release, which may be preferred by the patient [137], indicates a need to consider these competing priorities. Similarly, while many studies identified ways of reducing waste in orthopaedic surgery including greater use of reusable instruments, the finding from one study that reusable instrument sets had a greater carbon footprint in comparison to disposable sets indicates that evidence of environmental benefit is required before introducing changes to practice.
To better understand the environmental impact of health care for musculoskeletal conditions there is a need to identify and quantify the impact of care in terms of a carbon footprint, and implement standardised and valid metrics for routine collection across multiple institutions and government bodies [138, 139]. Collecting comparable carbon metrics associated with the delivery of musculoskeletal care such as CO2e emissions via life cycle assessment or the development of new carbon intensity metrics would facilitate accurate benchmarking, monitoring and transparent reporting of data that can be used to identify high emitters of greenhouse gases for targeting efforts to reduce them [138, 139]. The methods for collecting these metrics are complex and, as exemplified by the different results in comparing general to spinal anaesthesia across countries and by use of different LCA methods (cradle to gate or to grave metrics), specialised expertise is needed to be able to explain such differences.
Nine of the original research studies included in this review were waste audits that provided some information regarding the weight, volume and type of hospital waste associated with orthopaedic surgeries. However, the estimates had low precision and poor generalisability as they were based on a small number of surgical operations ranging from one to 55. While larger studies performed across multiple hospital sites would provide more representative samples of the waste produced from orthopaedic surgeries, the UK National Health Service (NHS) estimates that waste produced across the NHS healthcare system accounts for only 3% of the total carbon footprint of health care [7]. Future research on the environmental sustainability of orthopaedic surgery may therefore have greater impact if directed towards larger contributors of greenhouse gas emissions. Additionally, there may be opportunity for existing waste audit data to be quantified as CO2e emissions estimates using retrospective life cycle assessment methods, although this process requires a high level of expertise and is resource intensive [139].
Environmentally sustainable health care is needed across all health systems to minimise the direct and indirect harms it may be causing to our planet and its population [140]. In addition to collecting meaningful data using standardised carbon metrics, a framework by MacNeill et al. (2021) proposes three principles for achieving health system sustainability that can be directly applied to musculoskeletal care [141]. The first principle involves reducing the demand for health services. While this has grown as a consequence of ageing populations and population growth, public health policies are needed that prioritise disease prevention which will have additional benefits beyond musculoskeletal health. The second principle is to better match the supply and demand of health care and health support services across populations and settings, while the third is to reduce greenhouse gas emissions from the delivery of health care. The latter could be achieved by de-implementation of low value care, particularly targeting low-value tests and treatments with large carbon footprints, as well as expanding low carbon services such as telehealth across health systems. Many of the publications included in this review align with this third principle, although more carbon metrics are needed to further determine the largest contributors of greenhouse gas emissions within musculoskeletal health care.
The main strength of this review is that we used scoping review methodology to identify a broad range of studies and editorials across multiple disciplines. We also developed a comprehensive environment-themed search strategy through discussion with environmental scientists and after examining systematic reviews that had explored environmental sustainability for health care in other fields [2, 142]. We did this because we could not identify validated search strategies published for ‘environmental health’ or ‘environmental impact’.
A limitation to our database search is that we used the search strategy for musculoskeletal conditions used by Cochrane Musculoskeletal [143, 144], but this did not include broad anatomical terms (e.g. hand, wrist, elbow, shoulder etc.). To overcome this, we performed comprehensive Google and Google Scholar searches using anatomical, surgical, telehealth and environment themed keywords and also hand searched the reference lists of included publications to identify relevant publications and grey literature articles not published or indexed in biomedical databases. Our search identified narrative reviews that included 11 of our included original research studies and no additional relevant papers also minimising the likelihood of missing papers that would have appreciably altered our conclusions.
Conclusion
Despite an established link between health care and greenhouse gas emissions we found limited empirical data estimating the impact of musculoskeletal health care on the environment. Most of the studies we identified quantified the carbon footprint of aspects of orthopaedic surgery, particularly surgical waste, but there were limited data for other aspects of care such as imaging, pharmaceuticals and allied health care. Further data are needed to determine whether actions to lower the carbon footprint of musculoskeletal health care should be a priority and to identify those aspects of care that should be prioritised.
Supporting information
S3 Table. Focus and conclusions of editorials.
https://doi.org/10.1371/journal.pone.0276685.s005
(DOCX)
S4 Table. Focus and conclusions of literature reviews.
https://doi.org/10.1371/journal.pone.0276685.s006
(DOCX)
Acknowledgments
We would like to thank Diane Horrigan for her assistance in developing the database search strategies. We would also like to thank Zoe Rammelkamp for providing raw waste weight data of surgeries reported in the hospital waste audit by Rammelkamp et al. (2021) [89].
References
- 1. Patz JA, Thomson MC. Climate change and health: Moving from theory to practice. PLoS Medicine. 2018;15(7):1–5. pmid:30063707
- 2. Lenzen M, Malik A, Li M, Fry J, Weisz H, Pichler P-P, et al. The environmental footprint of health care: a global assessment. The Lancet Planetary Health. 2020;4(7):e271–e9. pmid:32681898
- 3. Eckelman MJ, Huang K, Lagasse R, Senay E, Dubrow R, Sherman JD. Health care pollution and public health damage in the United States: an update: study examines health care pollution and public health damage in the United States. Health Affairs. 2020;39(12):2071–9.
- 4. Malik A, Lenzen M, McAlister S, McGain F. The carbon footprint of Australian health care. The Lancet Planetary Health. 2018;2(1):e27–e35. pmid:29615206
- 5.
National Health Service. Delivering a ‘Net Zero’ National Health Service [Internet]. Leeds: NHS; 2022 July 4 [cited 2022 August 9]; [1 screen]. Available from: https://www.england.nhs.uk/greenernhs/publication/delivering-a-net-zero-national-health-service/.
- 6. Wu R. The carbon footprint of the Chinese health-care system: an environmentally extended input–output and structural path analysis study. The Lancet Planetary Health. 2019;3(10):e413–e9. pmid:31625513
- 7.
Karliner J, Slotterback S, Boyd R, Ashby B, Steele K. Health care’s climate footprint [Internet]. Health care without harm climate-smart series green paper number one. Reston: Health Care Without Harm; 2022 [cited 2022 June 12]. Available from: https://noharm-global.org/documents/health-care-climate-footprint-report.
- 8. Härtel CE, Pearman GI. Understanding and responding to the climate change issue: Towards a whole-of-science research agenda. Journal of Management & Organization. 2010;16(1):16–47.
- 9. Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA. 2012;307(14):1513–6. pmid:22419800
- 10. Saini V, Brownlee S, Elshaug AG, Glasziou P, Heath I. Addressing overuse and underuse around the world. The Lancet. 2017;390(10090):105–7. pmid:28077230
- 11. Saini V, Garcia-Armesto S, Klemperer D, Paris V, Elshaug AG, Brownlee S, et al. Drivers of poor medical care. The Lancet. 2017;390(10090):178–90. pmid:28077235
- 12. Bennell KL, Bayram C, Harrison C, Brand C, Buchbinder R, Haas R, et al. Trends in management of hip and knee osteoarthritis in general practice in Australia over an 11-year window: a nationwide cross-sectional survey. The Lancet Regional Health—Western Pacific. 2021;12:100187. pmid:34527976
- 13. Buchbinder R, van Tulder M, Öberg B, Costa LM, Woolf A, Schoene M, et al. Low back pain: a call for action. The Lancet. 2018;391(10137):2384–8. pmid:29573871
- 14. Thorpe A, Hurworth M, O’Sullivan P, Mitchell T, Smith A. Rising trends in surgery for rotator cuff disease in Western Australia. ANZ Journal of Surgery. 2016;86(10):801–4. pmid:27490156
- 15. Buchbinder R, Staples MP, Shanahan EM, Roos JF. General practitioner management of shoulder pain in comparison with rheumatologist expectation of care and best evidence: an Australian national survey. PLoS ONE. 2013;8(4):e61243. pmid:23613818
- 16. Naunton J, Harrison C, Britt H, Haines T, Malliaras P. General practice management of rotator cuff related shoulder pain: A reliance on ultrasound and injection guided care. PLoS ONE. 2020;15(1):e0227688. pmid:31929588
- 17. Zadro JR, Maher CG, Barton CJ. High‐and low‐value care in sport and exercise medicine: Areas for consideration. Translational Sports Medicine. 2020;3(5):395–403.
- 18. McGain F, Burnham JP, Lau R, Aye L, Kollef MH, McAlister S. The carbon footprint of treating patients with septic shock in the intensive care unit. Critical Care and Resuscitation: Journal of the Australasian Academy of Critical Care Medicine. 2018;20(4):304. pmid:30482138
- 19. Morris D, Wright T, Somner J, Connor A. The carbon footprint of cataract surgery. Eye. 2013;27(4):495–501. pmid:23429413
- 20. Bartlett S, Keir S. Calculating the carbon footprint of a Geriatric Medicine clinic before and after COVID-19. Age and Ageing. 2022;51(2):afab275.
- 21. Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D, et al. PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. Annals of Internal Medicine. 2018;169(7):467–73. pmid:30178033
- 22. Pandey D, Agrawal M, Pandey JS. Carbon footprint: current methods of estimation. Environmental Monitoring and Assessment. 2011;178(1):135–60. pmid:20848311
- 23.
Covidence systematic review software (2022). Veritas Health Innovation, Melbourne, Australia. Available at www.covidence.org.
- 24.
Google Translate [Internet]. California: Google; 2022. Available from: https://translate.google.com.au/.
- 25. Aoyama M. Occupational therapy and environmental sustainability. Australian Occupational Therapy Journal. 2014;61(6):458–61. pmid:25308152
- 26.
Baca S The technology age meets the green age: assistive technology reuse OT Practice 2009 Oct 26 p21-22.
- 27. Banerjee S, Maric F. Mitigating the environmental impact of NSAIDs-physiotherapy as a contribution to One Health and the SDGs. European Journal of Physiotherapy. 2021:1–5.
- 28. Dennis CW, Dorsey JA, Gitlow L. A call for sustainable practice in occupational therapy: Un appel à la pratique durable en ergothérapie. Canadian Journal of Occupational Therapy. 2015;82(3):160–8.
- 29. Epstein O. Green medicine. Journal of the Royal Society of Medicine. 2005;98(5):203–5. pmid:15863763
- 30. Foo R. The role of physiotherapy in climate change mitigation. Physiotherapy. 2016;102(3):e5. pmid:27137087
- 31. Hall AJ, Dunstan E. Day-case total hip arthroplasty: a safe and sustainable approach to improve satisfaction and productivity, and meet the needs of the orthopaedic population. Orthopaedics and Trauma. 2022.
- 32. Hofmann F, Stössel U. Environmental health in the health-care professions: biological, physical, psychic, and social health hazards. Reviews on Environmental Health. 1996;11(1–2):41–56. pmid:8869525
- 33. Howe GM. Disease and the environment in Britain. Journal of the Royal College of Physicians of London. 1974;8(2):127. pmid:4543928
- 34. Hrachovec JP. Environmental health and the older adult. Archives of Environmental Health: An International Journal. 1969;18(2):193–202. pmid:4886615
- 35. Kumar A. Regulating environmental impact of medical devices in the United Kingdom—a scoping review. Prosthesis. 2021;3(4):370–87.
- 36. Lieb LC. Occupation and environmental sustainability: A scoping review. Journal of Occupational Science. 2020:1–24.
- 37. Lieb LC. Occupational therapy in an ecological context: ethics and practice. The American Journal of Occupational Therapy. 2022;76(3).
- 38. Maric F, Nicholls DA. Environmental physiotherapy and the case for multispecies justice in planetary health. Physiotherapy Theory and Practice. 2021:1–12. pmid:34365892
- 39. Mower S, Thompson S. Medicine wastage in a thromboprophylaxis protocol for ambulatory trauma patients. Emergency Nurse. 2020;29(3):35–40.
- 40. Potteiger K, Pitney WA, Cappaert TA, Wolfe A. Athletic trainers’ attitudes and perceptions of environmental sustainability. Journal of Athletic Training. 2017;52(12):1109–20. pmid:29172650
- 41. Potteiger K, Pitney WA, Cappaert TA, Wolfe A. Examining the environmental effects of athletic training: perceptions of waste and the use of green techniques. Journal of Athletic Training. 2017;52(12):1121–30. pmid:29172649
- 42. Pradhan R, Peeters W, Boutong S, Mitchell C, Patel R, Faroug R, et al. Virtual phone clinics in orthopaedics: evaluation of clinical application and sustainability. BMJ Open Quality. 2021;10(4):e001349. pmid:34645613
- 43. Riley SA. Radiation exposure from fluoroscopy during orthopedic surgical procedures. Clinical Orthopaedics and Related Research. 1989(248):257–60. pmid:2805490
- 44. Sanders R, Koval KJ, DiPasquale T, Schmelling G, Stenzler S, Ross E. Exposure of the orthopaedic surgeon to radiation. The Journal of Bone and Joint Surgery American volume. 1993;75(3):326–30. pmid:8444910
- 45. Skubik-Peplaski CL, Howell D, Hunter E. The environmental impact on occupational therapy interventions. Occupational Therapy in Health Care. 2016;30(2):139–51. pmid:26365783
- 46. Soroceanu A, Canacari E, Brown E, Robinson A, McGuire KJ. Intraoperative waste in spine surgery: incidence, cost, and effectiveness of an educational program. Spine. 2011;36(19):E1270–E3. pmid:21738100
- 47. Taylor AL, Perret D, Morice K, Zafonte R, Skelton F, Rivers E, et al. Climate change and physiatry: a call to proportional and prospective action. American Journal of Physical Medicine & Rehabilitation. 2022.
- 48. Wagman P. How to contribute occupationally to ecological sustainability: A literature review. Scandinavian Journal of Occupational Therapy. 2014;21(3):161–5. pmid:24524695
- 49. Wyssusek KH, Keys MT, van Zundert AA. Operating room greening initiatives–the old, the new, and the way forward: a narrative review. Waste Management & Research. 2019;37(1):3–19.
- 50. Aldoori J, Hartley J, MacFie J. Sustainable surgery: in and out of the operating theatre. British Journal of Surgery. 2021;108(6):e219–e20. pmid:33713111
- 51. Campion N, Thiel CL, Woods NC, Swanzy L, Landis AE, Bilec MM. Sustainable healthcare and environmental life-cycle impacts of disposable supplies: a focus on disposable custom packs. Journal of Cleaner Production. 2015;94:46–55.
- 52. Raymond SB, Leslie-Mazwi TM, Hirsch JA. Greening the neurointerventional suite. Journal of NeuroInterventional Surgery. 2020;12(11):1037–8. pmid:32913004
- 53. Prasad PA, Joshi D, Lighter J, Agins J, Allen R, Collins M, et al. Environmental footprint of regular and intensive inpatient care in a large US hospital. The International Journal of Life Cycle Assessment. 2022;27(1):38–49.
- 54. Masino C, Rubinstein E, Lem L, Purdy B, Rossos PG. The impact of telemedicine on greenhouse gas emissions at an academic health science center in Canada. Telemedicine and e-Health. 2010;16(9):973–6. pmid:20958198
- 55. McAlister S, McGain F, Petersen M, Story D, Charlesworth K, Ison G, et al. The carbon footprint of hospital diagnostic imaging in Australia. The Lancet Regional Health—Western Pacific. 2022;24:100459. pmid:35538935
- 56. McGain F, Jarosz KM, Nguyen MNHH, Bates S, O’Shea CJ. Auditing operating room recycling: a management case report. A & A Case Reports. 2015;5(3):47–50. pmid:26230308
- 57. Nicolet J, Mueller Y, Paruta P, Boucher J, Senn N. What is the carbon footprint of primary care practices? A retrospective life-cycle analysis in Switzerland. Environmental Health. 2022;21(1):1–10.
- 58.
Abihssira S, Georsa T, Martelli N, De La Comble I, Gallo F, editors. How to improve orthopaedic surgery’s carbon footprint? Unexpected results of the comparison of single-use versus reusable medical devices in the treatment of distal radius fracture. Conference poster [cited 2 May 2022].
- 59. Fort J, Hughes H, Khan U, Glynn A. Social and environmental benefits of virtual fracture clinics in trauma and orthopaedic surgery: reduced patient travel time, patient cost and air pollutant emissions. British Journal of Surgery. 2021;108(Suppl 6):vi124.
- 60. Gillies M, Arnaud J. The unique challenges and opportunities of delivering a First Contact Physiotherapy (FCP) service to remote island communities in NHS Highland. Physiotherapy. 2021;113:e160–e1.
- 61.
Masmejean E, Abihssira S, editors. Carbon footprint in hand surgery: assessment of single use material versus conventional set for fixation of distal radius fracture. American Association for Hand Surgery Annual Meeting; 2022; Carlsbad, California USA.
- 62.
Mirkouei A, Silwal B, Ramiscal L, editors. Enhancing economic and environmental sustainability benefits across the design and manufacturing of medical devices: a case study of ankle foot orthosis. International Design Engineering Technical Conferences and Computers and Information in Engineering Conference; 2017: American Society of Mechanical Engineers.
- 63. Parkinson J, Mackie R, Parrott R. Physio near me: are virtual outpatient musculoskeletal (MSK) physiotherapy appointments an effective way to assess and manage patients? Physiotherapy. 2021;113:e149–e50.
- 64.
Pavlou P, Gardiner J, Pili D, Tayton E, editors. The environmental inpact of large joint arthroplasty. Orthopaedic Proceedings; 2010: The British Editorial Society of Bone & Joint Surgery.
- 65.
Reilly S, Taylor-Smith R, Wallace C, editors. Oral analgesic pre-medication in paediatric surgery: a practice with multiple benefits. Anaesthesia; 2021: Wiley 111 River St, Hoboken 07030–5774, NJ USA.
- 66. Rougereau G, Chatelain L, Conso C, Zadegan F. Estimation of the carbon footprint of arthroscopic rotator cuff repair in France. Orthopaedic Journal of Sports Medicine. 2022;10(Suppl 3).
- 67.
Cappucci GM, Pini M, Neri P, Marassi M, Bassoli E, Ferrari AM, editors. Evaluation of environmental sustainability in additive manufacturing processes for orthopaedic devices production. 12th Italian LCA Network Conference; 2018.
- 68. Carter J, Davies J. Carbon footprint of anesthesia: Comment. Anesthesiology. 2022. pmid:35507704
- 69. Gobert Q, Dernis L. Carbon footprint of anesthesia: Comment. Anesthesiology. 2022. pmid:35507703
- 70. Kalmar AF, Hendrickx JF, De Wolf A. Carbon footprint of anesthesia: Comment. Anesthesiology. 2022. pmid:35507687
- 71. Norman RM, Chad JM, Kelleher D. Carbon footprint of anesthesia: Comment. Anesthesiology. 2022. pmid:35507696
- 72. Schroeder K, Özelsel T, Ip V. Carbon footprint of anesthesia: Comment. Anesthesiology. 2022. pmid:35507701
- 73. Tsai MH, Kostrubiak MR, Rizzo DM. Carbon footprint of anesthesia: Comment. Anesthesiology. 2022. pmid:35507700
- 74. McGain F, Wickramarachchi K, Sheridan N, McAlister S. Carbon Footprint of Anesthesia: Reply. Anesthesiology. 2022. pmid:35507727
- 75. Purohit A, Smith J, Hibble A. Does telemedicine reduce the carbon footprint of healthcare? A systematic review. Future Healthcare Journal. 2021;8(1):e85. pmid:33791483
- 76. Ravindrane R, Patel J. The environmental impacts of telemedicine in place of face-to-face patient care: a systematic review. Future Healthcare Journal. 2022;9(1):28. pmid:35372776
- 77. Tsagkaris C, Hoian AV, Ahmad S, Essar MY, Campbell LW, Grobusch L, et al. Using telemedicine for a lower carbon footprint in healthcare: A twofold tale of healing. The Journal of Climate Change and Health. 2021;1:100006.
- 78. Wang AY, Ahsan T, Kosarchuk JJ, Liu P, Riesenburger RI, Kryzanski J. Dataset for carbon footprints of transforaminal lumbar interbody fusions performed under spinal or general anesthesia. Data in Brief. 2022;42(108218):1–5.
- 79.
Ayeni O, de SA D, Stephens K, Kuang M, Simunovic N, Karlsson J, editors. The direct environmental impact of hip arthroscopy for femoroacetabular impingement (FAI): a surgical waste audit. Orthopaedic Proceedings; 2016: The British Editorial Society of Bone & Joint Surgery.
- 80. Özelsel TJ, Ip VH, Sondekoppam RV. “Green-gional” anesthesia: a lot greener than you think. Regional Anesthesia & Pain Medicine. 2020.
- 81. Kuvadia M, Cummis CE, Liguori G, Wu CL. ‘Green-gional’ anesthesia: further considerations. Regional Anesthesia & Pain Medicine. 2020. pmid:32883716
- 82. Wu S, Cerceo E. Sustainability initiatives in the operating room. The Joint Commission Journal on Quality and Patient Safety. 2021;47(10):663–72. pmid:34344594
- 83. Baxter NB, Yoon AP, Chung KC. Variability in the Use of Disposable Surgical Supplies: A Surgeon Survey and Life Cycle Analysis. The Journal of Hand Surgery. 2021;46(12):1071–8. pmid:34275683
- 84. Bravo D, Thiel C, Bello R, Moses A, Paksima N, Melamed E. What a waste! The impact of unused surgical supplies in hand surgery and how we can improve. Hand. 2022. pmid:35485263
- 85. Zhang D, Dyer GS, Blazar P, Earp BE. The environmental impact of open versus endoscopic carpal tunnel release. The Journal of Hand Surgery. 2022. pmid:35123818
- 86. Wang AY, Ahsan T, Kosarchuk JJ, Liu P, Riesenburger RI, Kryzanski J. Assessing the environmental carbon footprint of spinal versus general anesthesia in single-level transforaminal lumbar interbody fusions. World Neurosurgery. 2022. pmid:35342029
- 87. Albert MG, Rothkopf DM. Operating room waste reduction in plastic and hand surgery. Plastic Surgery. 2015;23(4):235–8. pmid:26665137
- 88. Lee RJ, Mears SC. Reducing and recycling in joint arthroplasty. The Journal of Arthroplasty. 2012;27(10):1757–60. pmid:22704228
- 89. Rammelkamp Z, Dirnberger J, Johnson G, Waisbren S. An audit of all waste leaving the operating room: can the surgical suite be more environmentally sustainable? World Medical & Health Policy. 2021;13(1):126–36.
- 90. Thiel CL, Fiorin Carvalho R, Hess L, Tighe J, Laurence V, Bilec MM, et al. Minimal custom pack design and wide-awake hand surgery: reducing waste and spending in the orthopedic operating room. Hand. 2019;14(2):271–6. pmid:29183168
- 91. Wang EY, Zafar JE, Lawrence CM, Gavin LF, Mishra S, Boateng A, et al. Environmental emissions reduction of a preoperative evaluation center utilizing telehealth screening and standardized preoperative testing guidelines. Resources, Conservation and Recycling. 2021;171:105652.
- 92. de SA D, Stephens K, Kuang M, Simunovic N, Karlsson J, Ayeni OR. The direct environmental impact of hip arthroscopy for femoroacetabular impingement: a surgical waste audit of five cases. Journal of Hip Preservation Surgery. 2016;3(2):132–7. pmid:27583149
- 93. Kooner S, Hewison C, Sridharan S, Lui J, Matthewson G, Johal H, et al. Waste and recycling among orthopedic subspecialties. Canadian Journal of Surgery. 2020;63(3):E278. pmid:32437094
- 94. Stall NM, Kagoma YK, Bondy JN, Naudie D. Surgical waste audit of 5 total knee arthroplasties. Canadian Journal of Surgery. 2013;56(2):97–102. pmid:23351497
- 95. Lyons R, Newell A, Ghadimi P, Papakostas N. Environmental impacts of conventional and additive manufacturing for the production of Ti-6Al-4V knee implant: a life cycle approach. The International Journal of Advanced Manufacturing Technology. 2021;112(3):787–801.
- 96. Hennessy O, Diack M, Devitt A. Screwing our environment: an analysis of orthopaedic implant related waste. Irish Medical Journal. 2021;114(2):266–9.
- 97. Holmner Å, Ebi KL, Lazuardi L, Nilsson M. Carbon footprint of telemedicine solutions-unexplored opportunity for reducing carbon emissions in the health sector. PLoS ONE. 2014;9(9):e105040. pmid:25188322
- 98. Sand Lindskog H, Männer J. Reduced climate impact by resource-efficient surgeries. Lakartidningen. 2019;116:1–4.
- 99. McKendrick D, Snedden LJ, Bunch R, McGregor H. Pragmatic recycling of paper and cardboard in the operating theatre: an audit. Journal of Perioperative Practice. 2017;27(3):43–9. pmid:29328742
- 100. Southorn T, Norrish A, Gardner K, Baxandall R. Reducing the carbon footprint of the operating theatre: a multicentre quality improvement report. Journal of Perioperative Practice. 2013;23(6):144–6. pmid:23909168
- 101. McGain F, Sheridan N, Wickramarachchi K, Yates S, Chan B, McAlister S. Carbon footprint of general, regional, and combined anesthesia for total knee replacements. Anesthesiology. 2021;135(6):976–91. pmid:34529033
- 102. Marsault L, Ravn C, Overgaard A, Frich L, Olsen M, Anstensrud T, et al. Laminar airflow versus turbulent airflow in simulated total hip arthroplasty: measurements of colony-forming units, particles, and energy consumption. Journal of Hospital Infection. 2021;115:117–23. pmid:34182062
- 103. Leiden A, Cerdas F, Noriega D, Beyerlein J, Herrmann C. Life cycle assessment of a disposable and a reusable surgery instrument set for spinal fusion surgeries. Resources, Conservation and Recycling. 2020;156:104704.
- 104. Cappucci GM, Pini M, Neri P, Marassi M, Bassoli E, Ferrari AM. Environmental sustainability of orthopedic devices produced with powder bed fusion. Journal of Industrial Ecology. 2020;24(3):681–94.
- 105. Vukelic D, Budak I, Tadic B, Simunovic G, Kljajic V, Agarski B. Multi-criteria decision-making and life cycle assessment model for optimal product selection: case study of knee support. International Journal of Environmental Science and Technology. 2017;14(2):353–64.
- 106. Shinn HK, Hwang Y, Kim B-G, Yang C, Na W, Song J-H, et al. Segregation for reduction of regulated medical waste in the operating room: a case report. Korean Journal of Anesthesiology. 2017;70(1):100. pmid:28184276
- 107. Evans AM. Sustainable healthcare—Time for ‘Green Podiatry’. Journal of Foot and Ankle Research. 2021;14:1–5.
- 108. Evans AM. ‘Green podiatry’—reducing our carbon footprints. Lessons from a sustainability panel. Journal of Foot and Ankle Research. 2021;14:1–5.
- 109. Maric F, Chance-Larsen K, Chevan J, Jameson S, Nicholls D, Opsommer E, et al. A progress report on planetary health, environmental and sustainability education in physiotherapy—editorial. European Journal of Physiotherapy. 2021;23(4):201–2.
- 110. Jones L. Physiotherapy and the Earth’s global climate: a need for cultural change. Physiotherapy Research International. 2009;14(2):73–6. pmid:19459164
- 111. Stanhope J, Maric F, Rothmore P, Weinstein P. Physiotherapy and ecosystem services: improving the health of our patients, the population, and the environment. Physiotherapy Theory and Practice. 2021:1–14.
- 112. Garcia Diaz LV, Richardson J. Occupational therapy’s contributions to combating climate change and lifestyle diseases. Scandinavian Journal of Occupational Therapy. 2021:1–8. pmid:34663164
- 113.
Banerjee S. Can pre-operative physiotherapy reduce the carbon footprint of hospitals? [Internet]. Environmental Physiotherapy Association; 2020 Nov 4 [cited 2022 May 3]; [about 2 screens]. Available from: http://environmentalphysio.com/2020/11/04/can-pre-operative-physiotherapy-reduce-the-carbon-footprint-of-hospitals/.
- 114. Maric F, Groven K, Banerjee S, Dahl-Michelsen T. Essentials for sustainable physiotherapy: introducing environmental reasoning into physiotherapy clinical decision-making. Fysioterapeuten 2021. p. 54–8.
- 115. Maric F, Nicholls D. A call for a new environmental physiotherapy—an editorial. Physiotherapy Theory and Practice. 2019;35(10):905–7. pmid:31257964
- 116. Maric F, Griech SF, Davenport TE. Advancing environmental stewardship in physical therapy: Connect, learn, act. Cardiopulmonary Physical Therapy Journal. 2022;33(1):2–4.
- 117. Lidgren L, Raina DB, Tägil M, Tanner KE. Recycling implants: a sustainable solution for musculoskeletal research. Acta Orthopaedica. 2020;91(2):125. pmid:31902268
- 118. Palstam A, Andersson M, Lange E, Grenholm A. A call to include a perspective of sustainable development in physical therapy research. Physical Therapy & Rehabilitation Journal. 2021;101(3):1–4.
- 119. Bruyneel A-V. Environmental impact of health, which actions in physiotherapy for a respectful approach to the planet? Kinesitherapie. 2020;20(221):1–2.
- 120. Borg T-M. How can we make hand surgery carbon neutral? Hand. 2021. pmid:34738480
- 121.
Chan G, Sinclair L, Rizan C, Bendall S, Bhutta MF, Rogers B, et al. Sustainable orthopaedic surgery An oxymoron? [Internet] London: British Orthopaedic Association; 2021 Oct 18 [cited 2022 May 2]; [about 3 screens] Available from: https://wwwboaacuk/resources/knowledge-hub/sustainable-orthopaedic-surgery-an-oxymoronhtml.
- 122. Dickson K, Cooper K, Gardiner MD. Perspectives on climate change: can hand surgery go carbon neutral? Journal of Hand Surgery (European Volume). 2022:17531934221096786. pmid:35502001
- 123. Greer R. 3rd On recycling in the operating room. Orthopaedic Review. 1994;23(12):928. pmid:7885723
- 124. Kuvadia M, Cummis CE, Liguori G, Wu CL. ’Green-gional’ anesthesia: the non-polluting benefits of regional anesthesia to decrease greenhouse gases and attenuate climate change. Regional Anesthesia & Pain Medicine. 2020;45(9):744–5. pmid:32546552
- 125. Shahi S, Kellish A, Tornsberg H, Miller L. What is orthopaedic surgery’s environmental impact? AAOS Now. 2021.
- 126. Lee RJ, Mears SC. Greening of orthopedic surgery. Orthopedics. 2012;35(6):e940–e4. pmid:22691671
- 127. Van Demark RE Jr, Smith VJ, Fiegen A. Lean and green hand surgery. The Journal of Hand Surgery. 2018;43(2):179–81. pmid:29421068
- 128. Bravo D, Gaston RG, Melamed E. Environmentally responsible hand surgery: past, present, and future. The Journal of Hand Surgery. 2020;45(5):444–8. pmid:31928797
- 129. Engler ID, Curley AJ, Fu FH, Bilec MM. Environmental sustainability in orthopaedic surgery. Journal of the American Academy of Orthopaedic Surgeons. 2022:1–8.
- 130. Yadav D, Garg RK, Ahlawat A, Chhabra D. 3D printable biomaterials for orthopedic implants: Solution for sustainable and circular economy. Resources Policy. 2020;68:101767.
- 131. Ma Y, Han S. Carbon neutral hand surgery: simple changes to reduce carbon footprint. Plastic Surgery. 2022; (online first).
- 132. Leduc G, Mongelli I, Uihlein A, Nemry F. How can our cars become less polluting? An assessment of the environmental improvement potential of cars. Transport Policy. 2010;17(6):409–19.
- 133. Lenzen M. Total requirements of energy and greenhouse gases for Australian transport. Transportation Research Part D: Transport and Environment. 1999;4(4):265–90.
- 134. Thiel CL, Eckelman M, Guido R, Huddleston M, Landis AE, Sherman J, et al. Environmental impacts of surgical procedures: life cycle assessment of hysterectomy in the United States. Environmental science & technology. 2015;49(3):1779–86. pmid:25517602
- 135. Woods DL, McAndrew T, Nevadunsky N, Hou JY, Goldberg G, Yi‐Shin Kuo D, et al. Carbon footprint of robotically‐assisted laparoscopy, laparoscopy and laparotomy: a comparison. The International Journal of Medical Robotics and Computer Assisted Surgery. 2015;11(4):406–12. pmid:25708320
- 136. MacNeill AJ, Lillywhite R, Brown CJ. The impact of surgery on global climate: a carbon footprinting study of operating theatres in three health systems. The Lancet Planetary Health. 2017;1(9):e381–e8. pmid:29851650
- 137. Li Y, Luo W, Wu G, Cui S, Zhang Z, Gu X. Open versus endoscopic carpal tunnel release: a systematic review and meta-analysis of randomized controlled trials. BMC Musculoskeletal Disorders. 2020;21(1):1–16. pmid:32340621
- 138. Salas RN, Maibach E, Pencheon D, Watts N, Frumkin H. A pathway to net zero emissions for healthcare. BMJ. 2020;371. pmid:33004403
- 139. Hensher M, McGain F. Health care sustainability metrics: building a safer, low-carbon health system. Health Affairs. 2020;39(12):2080–7. pmid:33284706
- 140.
World Health Organization Regional Office for Europe. Environmentally sustainable health systems: a strategic document. Copenhagen, Denmark: WHO; 2017 [cited 12 June 2022]. Available from: https://apps.who.int/iris/handle/10665/340375.
- 141. MacNeill AJ, McGain F, Sherman JD. Planetary health care: a framework for sustainable health systems. The Lancet Planetary Health. 2021;5(2):e66–e8. pmid:33581064
- 142. McGain F, Naylor C. Environmental sustainability in hospitals–a systematic review and research agenda. Journal of Health Services Research & Policy. 2014;19(4):245–52. pmid:24813186
- 143.
Cochrane Musculoskeletal [Internet]. London UK: Cochrane; 2022 [cited 2022 June 12]. Available from: https://musculoskeletal.cochrane.org/welcome.
- 144. Bourne AM, Johnston RV, Cyril S, Briggs AM, Clavisi O, Duque G, et al. Scoping review of priority setting of research topics for musculoskeletal conditions. BMJ Open. 2018;8(12):e023962. pmid:30559158