Assessing the Environmental Impact Associated With Disruptive Surgical Bleeding

OBJECTIVES: Disruptive bleeding remains a common complication of surgical procedures. Although hemostatic agents are an effective treatment option to control bleeding, some patients experience disruptive bleeding despite the use of hemostats. Whilst the clinical and economic burden of disruptive bleeding has been well studied, its environmental impact is less understood. This research aims to analyse the environmental impact associated with disruptive bleeding due to the subsequent increase in healthcare resource use (HRU).

METHODS: An environmental impact model was developed. Clinical and HRU data to compare outcomes between patients receiving hemostats with vs. without disruptive bleeding were sourced from the retrospective analysis of the Premier Healthcare Database for the selected surgical procedures of interest: cholecystectomy, coronary artery bypass grafting, cystectomy, hepatectomy, hysterectomy, lung resection, pancreatectomy, peripheral vascular and valve. Sustainability data were obtained from the Sustainable Healthcare Coalition’s Care Pathways Guidance. Outcomes assessed were greenhouse gas emissions, water use, and waste generated.

RESULTS: Patients with disruptive bleeding were associated with more ICU days (up to 1.6) and LOS days (up to 6.3), longer operative time (up to 35%), and higher readmission rates at 30 days (up to 13%) for the selected procedures of interest. The environmental impact of disruptive bleeding was estimated to incur up to 309.8 kg CO₂e, 484.5 m³ water use, and 36.1 kg waste for the selected procedures of interest. Achieving effective and timely control for surgical bleeding events could save up to 96 tonnes of CO₂e (equivalent to 340 return flights from London to Rome), 152,840 m³ of water use, and 12 tonnes of waste per 1,000 surgical procedures.

CONCLUSIONS: Disruptive bleeding is associated with a substantial environmental impact. By timely and effective control of disruptive bleeding, healthcare facilities may improve their environmental sustainability in addition to reducing the clinical and economic burden of this complication.