A systematic review of sustainability practices in plastic surgery.

[AIM] There is an urgent need to mitigate the environmental impact of surgery, with surgery representing a major contributor to carbon emissions. This study explores literature detailing current sustainability practices and initiatives in plastic surgery and evaluates methods used to facilitate the attainment of net zero targets.

[METHODOLOGY] Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, a systematic search was performed using MEDLINE, EMBASE and Cochrane Library databases (PROSPERO registration number CRD42023446104). Studies pertaining to sustainability practices in plastic surgery were included.

[RESULTS] An initial search yielded 1083 studies, of which 15 met inclusion criteria. The studies were analysed for data on waste, carbon footprint and cost reduction. Hand surgery was the leading subspecialty with initiatives to tackle waste, such as using procedure-specific surgical packs of the Wide-Awake Local Anaesthesia No Tourniquet technique, while also considering surgeons' preferences. Other initiatives were implemented in craniofacial, skin cancer and breast surgery. Successful recycling initiatives were reported with a monthly average of 39.6 tonnes of waste redirected to be recycled per month. Five studies, from skin and hand surgery, demonstrated a simultaneous benefit through reduction in cost by individualising sustainability practices for specific procedures. The average carbon footprint per procedure, of the included studies reporting emissions, was 22.7 kgCO-eq.

[CONCLUSION] This systematic review demonstrated the necessity of an agile approach towards implementing sustainability practices, tailoring sustainability strategies to the requirements of each surgical procedure. The development of standardised outcome sets to evaluate the best practices in sustainability was emphasised.