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Cited by 400Environmental Impact and SustainabilityHealthcare Facilities Design and SustainabilityHealthcare Operations and Scheduling Optimization

The DOI matches its Crossref record; 50 of the 54 references it cites were found in a registry or an index; 46 of the 133 sources its claims cite were checked for support.

The Carbon Footprint of Surgical Operations

Open access
Rizan, Chantelle, Steinbach, Ingeborg, Nicholson, Rosamond, Lillywhite, Rob, Reed, Malcolm, Bhutta, Mahmood F.·2020·Annals of Surgery
DOI 10.1097/sla.0000000000003951
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Abstract

Systematic review finding operating theatres are 3-6 times more energy-intensive than the rest of the hospital and that major hotspots include electricity use and procurement of consumables.

Overview

Integrity signals

Registry

Crossref · 10.1097/sla.0000000000003951

Cites

50 of 50 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Verification

Claims the paper makes

46 of 133 cited sources checked · 27 supported · 3 flagged · accuracy not yet measured

  • Findingcitation

    Four studies found procurement to be the largest hotspot.

    “By contrast, four studies (7,27,33,34) found procurement to be the largest hotspot”
    Quote in the paperSubstantial claim2 of 4 sources checked
    • cites [7] 7. 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. Environ Sci Technol. 2015;49(3):1779-86. source
    • cites [27] 27. Morris DS, Wright T, Somner JE, Connor A. The carbon footprint of cataract surgery. Eye. 2013;27(4):495-501. source
    • cites [33] 33. Thiel CL, Woods NC, Bilec MM. Strategies to reduce greenhouse gas emissions from laparoscopic surgery. Am J Public Health. 2018;108(S2):S158-S64. source
    • cites [34] 34. Thiel CL, Schehlein E, Ravilla T, Ravindran RD, Robin AL, Saeedi OJ, et al. Cataract surgery and environmental sustainability: Waste and lifecycle assessment of phacoemulsification at a private healthcare facility. J Cataract Refract Surg. 2017;43(11):1391-8. source

      The Results (Lifecycle Assessment Results; page not available in our copy) identify sterilization of reusable instruments—not procurement—as the dominant source of emissions in this study. The Discussion says procurement accounts for over 50% of the UK cataract-surgery carbon footprint, but distinguishes that comparison from the study’s Aravind findings. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Study design and conductcitation

    One study did not state either assumptions or exclusions.

    “and one(7) did not state either.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [7] 7. 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. Environ Sci Technol. 2015;49(3):1779-86. source

      The Experimental Methods specify the study’s system boundaries, from when the patient enters the operating room until she leaves. The Monte Carlo Analysis of Variability and Uncertainty section also explicitly states an exclusion: recycling impacts were omitted from that analysis and added to the post-analysis results. The claim that the paper stated neither assumptions nor exclusions is therefore contrary to our copy (page numbers unavailable). (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured
  • Premisecitation

    The relative contributions of each principal component of an operating theatre carbon footprint are disputed.

    “The relative contributions of each of these components is disputed, (12,26,27)”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [12] 12. MacNeill A, Lillywhite R, Brown C. 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. source

      The Discussion (p. 6) compares the relative contributions of emissions sources across three hospitals and reports a marked difference in anaesthetic-gas emissions. It does not say that the contributions are disputed; variation between sites is not evidence of a dispute. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [26] 26. Berner JE, Gras MDP, Troisi L, Chapman T, Vidal P. Measuring the carbon footprint of plastic surgery: A preliminary experience in a Chilean teaching hospital. J Plast Reconstr Aesthet Surg. 2017;70(12):1777-9. source
    • cites [27] 27. Morris DS, Wright T, Somner JE, Connor A. The carbon footprint of cataract surgery. Eye. 2013;27(4):495-501. source
  • Premisecitation

    Previous reviews of environmental sustainability of operating theatres have mostly focused on waste management strategies, encouraging reduction, reuse and recycling.

    “Previous reviews of the environmental sustainability of operating theatres have mostly focused on waste management strategies, encouraging reduction, reuse and recycling (alongside 'rethinking' and research).(23,24)”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [23] 23. Kagoma Y, Stall N, Rubinstein E, Naudie D. People, planet and profits: the case for greening operating rooms. CMAJ. 2012;184(17):1905-11. source
    • cites [24] 24. Guetter CR, Williams BJ, Slama E, Arrington A, Henry MC, Möller MG, et al. Greening the operating room. Am J Surg. 2018. source
  • Findingcitation

    In two studies where electricity use was broken down, the highest consumption of electricity was for maintaining the theatre environment (heating, ventilation and air-conditioning).

    “In two studies where electricity use was broken down, the highest consumption of electricity was for maintaining the theatre environment (heating, ventilation and air-conditioning).(7,31)”
    Quote in the paperNot a substantial claim2 of 2 sources checked
    • cites [7] 7. 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. Environ Sci Technol. 2015;49(3):1779-86. source

      The Results section (Life Cycle Impacts of Hysterectomy; page unavailable) says operating-room HVAC caused over 70% of energy impacts, more than the reported contribution from electricity for operating-room machines. That supports HVAC as the leading energy-related contributor in this study, but the passage measures environmental impacts rather than directly reporting that HVAC consumed the most electricity. The other study cited in the sentence is outside this verdict. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
    • cites [31] 31. Campion N, Thiel CL, DeBlois J, Woods NC, Landis AE, Bilec MM. Life cycle assessment perspectives on delivering an infant in the US. Sci Total Environ. 2012;425:191- 8. source

      The Methods (§2.1) separately estimate machinery, lighting, and HVAC energy use for delivery rooms, including an operating room. Results (§3.3) say those loads collectively contributed the highest percentage to several environmental impacts, but do not establish that HVAC alone consumed the most electricity. This paper also cannot substantiate the claim about both cited studies. (LLM, conf=0.82)

      Experimental — accuracy not yet measured
  • It may state two separate claims as one. 38
  • Probably not a substantial claim. 35

  • It may state two separate claims as one.

    Findingcitation

    Three studies specifically identified single-use items as the largest contributors, responsible for up to 78% of the carbon footprint, with two of these studies referring to the same dataset.

    “with three (7,33,34) specifically identifying single-use items to be largest contributors, responsible for up to 78% of the carbon footprint”
    Quote in the paperNot a substantial claim2 of 3 sources checked
    • cites [7] 7. 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. Environ Sci Technol. 2015;49(3):1779-86. source

      The Discussion (Impacts in the Supply Chain: Packaging and Purchasing; page unavailable) says single-use materials and tools accounted for a majority of environmental impacts in nearly every category. It does not give a 78% share of the carbon footprint; the Results (Life Cycle Impacts of Hysterectomy; page unavailable) instead say anesthetic gases contributed about two-thirds of greenhouse gas emissions for abdominal and vaginal hysterectomies. This paper also does not establish that two of the three cited studies used the same dataset. (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [33] 33. Thiel CL, Woods NC, Bilec MM. Strategies to reduce greenhouse gas emissions from laparoscopic surgery. Am J Public Health. 2018;108(S2):S158-S64. source
    • cites [34] 34. Thiel CL, Schehlein E, Ravilla T, Ravindran RD, Robin AL, Saeedi OJ, et al. Cataract surgery and environmental sustainability: Waste and lifecycle assessment of phacoemulsification at a private healthcare facility. J Cataract Refract Surg. 2017;43(11):1391-8. source

      The Results (Lifecycle Assessment Results; page unavailable) identify reusable instruments and their sterilization—not single-use items—as responsible for more than half of emissions in most impact categories. Single-use materials contribute the largest share only to ozone depletion. The paper does not report that they account for up to 78% of the carbon footprint. (LLM, conf=0.88)

      Checked by a reasoning model — may be wrong.

      Experimental — accuracy not yet measured

  • It may state two separate claims as one.

    Premisecitation

    Operating rooms make a large contribution to the healthcare carbon footprint as they are typically the most resource-intensive area of a hospital.

    “Operating rooms make a large contribution to the healthcare carbon footprint as they are typically the most resource-intensive area of a hospital.(7,8)”
    Quote in the paperSubstantial claim1 of 2 sources checked
    • cites [7] 7. 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. Environ Sci Technol. 2015;49(3):1779-86. source
    • cites [8] 8. Lee BK, Ellenbecker MJ, Moure-Eraso R. Analyses of the recycling potential of medical plastic wastes. Waste Manag. 2002;22(5):461-70. source

  • It may state two separate claims as one.

    Premisecitation

    Operating rooms are three to six times more energy intensive than the rest of the hospital, largely attributable to maintenance of the theatre environment (heating, ventilation and air-conditioning).

    “and are three to six times more energy intensive than the rest of the hospital which can be largely attributed to maintenance of the theatre environment (heating, ventilation and air-conditioning).(12)”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] 12. MacNeill A, Lillywhite R, Brown C. 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. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    Hybrid methods exist which attempt either to incorporate the detail of the process-based approach alongside inclusivity of EEIO models, or which use top-down approaches for attributable components for which process data cannot be obtained.

    “Hybrid methods exist which attempt either to incorporate the detail of the process-based approach alongside inclusivity of EEIO models, or which use top-down approaches for attributable components for which process data cannot be obtained.(19,21)”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [19] 19. Berners-Lee M, Howard DC, Moss J, Kaivanto K, Scott WA. Greenhouse gas footprinting for small businesses-the use of input-output data. Sci Total Environ. 2011;409(5):883-91. source
    • cites [21] 21. Pomponi F, Lenzen M. Hybrid life cycle assessment (LCA) will likely yield more accurate results than process-based LCA. Journal of Cleaner Production. 2018;176:210-5. source

      Section 5 describes coupling multiregional input-output databases to process-based LCA, supporting the claim that hybrid methods combine the two approaches. The Conclusions discuss process-based truncation errors, but the passages do not say that hybrid methods use top-down estimates specifically for components whose process data cannot be obtained. No page numbers are available in our copy. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • It may state two separate claims as one.

    Findingown data

    Five included studies used a hybrid approach using both EEIO and process-based methodologies; three termed this EIOLCA and one a component analysis study.

    “Five studies used a hybrid approach, using both EEIO and process-based methodologies, of which three termed this an 'economic-' or 'environment input-output life cycle assessment (EIOLCA)' (7,33,34) and one a 'component analysis study'.(27)”
    Quote in the paperNot a substantial claim2 of 4 sources checked
    • cites [7] 7. 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. Environ Sci Technol. 2015;49(3):1779-86. source
    • cites [33] 33. Thiel CL, Woods NC, Bilec MM. Strategies to reduce greenhouse gas emissions from laparoscopic surgery. Am J Public Health. 2018;108(S2):S158-S64. source
    • cites [34] 34. Thiel CL, Schehlein E, Ravilla T, Ravindran RD, Robin AL, Saeedi OJ, et al. Cataract surgery and environmental sustainability: Waste and lifecycle assessment of phacoemulsification at a private healthcare facility. J Cataract Refract Surg. 2017;43(11):1391-8. source

      Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites [27] 27. Morris DS, Wright T, Somner JE, Connor A. The carbon footprint of cataract surgery. Eye. 2013;27(4):495-501. source

  • It may state two separate claims as one.

    Findingown data

    Three included studies exclusively used bottom-up process-based approaches; one described their method as a carbon footprint, one as a multi-component analysis/carbon footprint, and one conducted full LCA.

    “Three studies exclusively used 'bottom-up' process-based approaches, of which one simply described their method as a 'carbon footprint',(35) one described it as a 'multi-component analysis/carbon footprint', (26) and the other conducted full LCA.(31)”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [35] 35. 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. Int J Med Robot. 2015;11(4):406-12. source
    • cites [26] 26. Berner JE, Gras MDP, Troisi L, Chapman T, Vidal P. Measuring the carbon footprint of plastic surgery: A preliminary experience in a Chilean teaching hospital. J Plast Reconstr Aesthet Surg. 2017;70(12):1777-9. source
    • cites [31] 31. Campion N, Thiel CL, DeBlois J, Woods NC, Landis AE, Bilec MM. Life cycle assessment perspectives on delivering an infant in the US. Sci Total Environ. 2012;425:191- 8. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    There is debate between the relative accuracy and value of top-down and bottom-up approaches.

    “There is debate between the relative accuracy and value of top-down and bottom-up approaches.(21)”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [21] 21. Pomponi F, Lenzen M. Hybrid life cycle assessment (LCA) will likely yield more accurate results than process-based LCA. Journal of Cleaner Production. 2018;176:210-5. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    Published emission factors can be applied to provide average emissions for attributable processes, enabling detailed analysis with high specificity and allowing comparison between items from the same sector.

    “Published emission factors can be applied, which provide average emissions for given attributable processes (for example electricity consumption, transportation, and production of a given material).This enables detailed analysis with high specificity, allowing comparison between items from the same sector.(20)”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [20] 20. Kennelly C, Berners-Lee M, Hewitt C. Hybrid life-cycle assessment for robust, best- practice carbon accounting. Journal of Cleaner Production. 2019;208:35-43. source

      Section 2.2 describes process-based carbon accounting as an itemised estimate of emissions at each step of a product’s life cycle, supporting the detailed-analysis part of the claim. Section 4.1 also discusses calculated emission factors. The passages do not establish that applying published average factors provides high specificity or enables comparisons between items within the same sector; those parts are unsupported by our copy. (LLM, conf=0.79)

      Experimental — accuracy not yet measured

  • It may state two separate claims as one.

    Findingown data

    Three included studies used primary process activity data only, one used secondary financial activity data only, and all others used a mixture of data types.

    “Three studies used primary process activity data only, (26,31,35) one used secondary financial activity data only (32) and all others used a mixture of data types (Supplementary Table 3).(7,27,33,34)”
    Quote in the paperNot a substantial claim3 of 8 sources checked
    • cites [26] 26. Berner JE, Gras MDP, Troisi L, Chapman T, Vidal P. Measuring the carbon footprint of plastic surgery: A preliminary experience in a Chilean teaching hospital. J Plast Reconstr Aesthet Surg. 2017;70(12):1777-9. source
    • cites [31] 31. Campion N, Thiel CL, DeBlois J, Woods NC, Landis AE, Bilec MM. Life cycle assessment perspectives on delivering an infant in the US. Sci Total Environ. 2012;425:191- 8. source
    • cites [35] 35. 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. Int J Med Robot. 2015;11(4):406-12. source
    • cites [32] 32. Gatenby PA. Modelling the carbon footprint of reflux control. Int J Surg. 2011;9(1):72-4.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [7] 7. 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. Environ Sci Technol. 2015;49(3):1779-86. source
    • cites [27] 27. Morris DS, Wright T, Somner JE, Connor A. The carbon footprint of cataract surgery. Eye. 2013;27(4):495-501. source
    • cites [33] 33. Thiel CL, Woods NC, Bilec MM. Strategies to reduce greenhouse gas emissions from laparoscopic surgery. Am J Public Health. 2018;108(S2):S158-S64. source
    • cites [34] 34. Thiel CL, Schehlein E, Ravilla T, Ravindran RD, Robin AL, Saeedi OJ, et al. Cataract surgery and environmental sustainability: Waste and lifecycle assessment of phacoemulsification at a private healthcare facility. J Cataract Refract Surg. 2017;43(11):1391-8. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingcitation

    The carbon footprint of a caesarean section is twice that of a vaginal delivery.

    “Campion et al. (31) found that the carbon footprint of a caesarean section is twice that of a vaginal delivery.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [31] 31. Campion N, Thiel CL, DeBlois J, Woods NC, Landis AE, Bilec MM. Life cycle assessment perspectives on delivering an infant in the US. Sci Total Environ. 2012;425:191- 8. source

      Section 3.1 (page not provided) says cesarean births have a higher environmental footprint than vaginal births. The Results and Discussion discuss global warming potential for both delivery modes, but the passages do not give a two-to-one carbon-footprint comparison. The claimed magnitude is therefore unsupported by our copy. (LLM, conf=0.82)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingcitation

    Allocation methods were explicitly stated by four included studies.

    “Allocation methods were explicitly stated by four studies.(7,31,33,34)”
    Quote in the paperNot a substantial claim3 of 4 sources checked
    • cites [7] 7. 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. Environ Sci Technol. 2015;49(3):1779-86. source
    • cites [31] 31. Campion N, Thiel CL, DeBlois J, Woods NC, Landis AE, Bilec MM. Life cycle assessment perspectives on delivering an infant in the US. Sci Total Environ. 2012;425:191- 8. source
    • cites [33] 33. Thiel CL, Woods NC, Bilec MM. Strategies to reduce greenhouse gas emissions from laparoscopic surgery. Am J Public Health. 2018;108(S2):S158-S64. source
    • cites [34] 34. Thiel CL, Schehlein E, Ravilla T, Ravindran RD, Robin AL, Saeedi OJ, et al. Cataract surgery and environmental sustainability: Waste and lifecycle assessment of phacoemulsification at a private healthcare facility. J Cataract Refract Surg. 2017;43(11):1391-8. source

  • It may state two separate claims as one.

    Findingcitation

    Three studies found electricity to be the largest source of GHG emissions, accounting for 63-78% of the carbon footprint of whole operations.

    “Three studies (26,31,35) found electricity to be the largest source of GHG emissions, accounting for 63-78% of the carbon footprint of whole operations”
    Quote in the paperNot a substantial claim1 of 3 sources checked
    • cites [26] 26. Berner JE, Gras MDP, Troisi L, Chapman T, Vidal P. Measuring the carbon footprint of plastic surgery: A preliminary experience in a Chilean teaching hospital. J Plast Reconstr Aesthet Surg. 2017;70(12):1777-9. source
    • cites [31] 31. Campion N, Thiel CL, DeBlois J, Woods NC, Landis AE, Bilec MM. Life cycle assessment perspectives on delivering an infant in the US. Sci Total Environ. 2012;425:191- 8. source

      The Results and Discussion section reports that machines, lighting, and HVAC contributed the largest share of global warming potential for both delivery modes. It attributes those impacts to electricity and natural gas together, not electricity alone. The passages do not give a 63–78% share or assess whole operations rather than individual births (page unavailable in our copy). (LLM, conf=0.86)

      Experimental — accuracy not yet measured
    • cites [35] 35. 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. Int J Med Robot. 2015;11(4):406-12. source

  • It may state two separate claims as one.

    Premisecitation

    Average operation emissions in MacNeill et al. were 146 kg CO2e per average case at the Canadian hospital, 173 kg CO2e in the UK, and 232 kg CO2e in the US, in keeping with included studies.

    “results of average operations were in keeping with included studies, with emissions of 146 kg CO2e per average case at the Canadian hospital, compared with 173 kg CO2e in the UK, and 232 kg CO2e in the US.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] 12. MacNeill A, Lillywhite R, Brown C. 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. source

  • It may state two separate claims as one.

    Premisecitation

    MacNeill et al. calculated and compared the carbon footprint of whole operating suites across one year in three large hospitals in the UK, Canada and US, finding this ranged between 3,219-5,188 tonnes CO2e.

    “MacNeill et al. calculated and compared the carbon footprint of whole operating suites across one year in three large hospitals in the UK, Canada and US, (12) finding this ranged between 3,219-5,188 tonnes CO2e.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [12] 12. MacNeill A, Lillywhite R, Brown C. 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. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductcitation

    Parameter uncertainty was calculated by two studies.

    “Parameter uncertainty (uncertainty relating to the data collection or emissions factors) was calculated by two studies.(7,35)”
    Quote in the paperNot a substantial claim1 of 2 sources checked
    • cites [7] 7. 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. Environ Sci Technol. 2015;49(3):1779-86. source
    • cites [35] 35. 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. Int J Med Robot. 2015;11(4):406-12. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductcitation

    One study reported only descriptive or graphical data.

    “One study reported only descriptive or graphical data.(31)”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [31] 31. Campion N, Thiel CL, DeBlois J, Woods NC, Landis AE, Bilec MM. Life cycle assessment perspectives on delivering an infant in the US. Sci Total Environ. 2012;425:191- 8. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingown data

    A top-down EEIO was used exclusively by one included study but was referred to as a carbon footprint.

    “A 'top-down' EEIO was used exclusively by one study (35) but was referred to as a 'carbon footprint'.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] 35. 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. Int J Med Robot. 2015;11(4):406-12. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Findingown data

    Screening of titles excluded 4,381 records; of the remaining 223, 83 were duplicates, leaving 140 articles for full text evaluation.

    “Screening of titles excluded 4,381 of these and of the remaining 223, 83 were duplicates, leaving 140 articles for full text evaluation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingown data

    The search strategy identified 4,604 records.

    “The search strategy identified 4,604 records (Figure 1).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Findingown data

    Of the eight included studies, four were conducted exclusively in the US, two in the UK, one in Chile, and one in India.

    “Of these, four were conducted exclusively in the US, (7,31,33,35) two in the UK, (27,32), one in Chile (26), and one in India (Table 1).(34)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Findingreasoning

    Other included studies did not specify the number of GHGs included, although this can be deduced based on the guidelines or databases used.

    “Other studies did not specify the number of GHGs included, (7,31,(33)(34)(35) although this can be deduced (bracketed in Table 1) based on the guidelines or databases used.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingnone given

    The functional unit of all included studies was individual operations.

    “The functional unit of all included studies were individual operations.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingcitation

    Four included studies reported following ISO guidelines, one following the GHG Protocol, and two using PAS 2050 guidelines.

    “Four studies (7,31,33,34) reported following ISO guidelines,(16) one(35) following the GHG Protocol(14) and two (27,35) using PAS 2050 guidelines.(15)”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [16] 16. International Organization for Standardization. ISO 14040:2006 Environmental management-life cycle assessment-principles and framework. Geneva, Switzerland: ISO; 2006.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [14] 14. World Resources Institute. Greenhouse gas protocol, product life cycle accounting and reporting standard. USA: World Resources Institute; 2011.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [15] 15. Department for Business Innovation and Skills. PAS 2050:2011 Specification for the assessment of the life cycle greenhouse gas emissions of goods and services. UK: Department for Business Innovation and Skills; 2011.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • It may state two separate claims as one.

    Findingown data

    Four included studies examined operations in Obstetrics and Gynaecology, two Ophthalmological operations, one Gastrointestinal, and one Plastic surgery.

    “Four studies examined operations in the field of Obstetrics and Gynaecology, (7,31,33,35) two Ophthalmological operations, (27,34) one Gastrointestinal, (32), and one Plastic surgery.(26)”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingown data

    Two included studies calculated CO2 emissions only.

    “With regards to the scope of GHGs included, two studies calculated CO2 emissions only.(26,32)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [26] 26. Berner JE, Gras MDP, Troisi L, Chapman T, Vidal P. Measuring the carbon footprint of plastic surgery: A preliminary experience in a Chilean teaching hospital. J Plast Reconstr Aesthet Surg. 2017;70(12):1777-9. source
    • cites [32] 32. Gatenby PA. Modelling the carbon footprint of reflux control. Int J Surg. 2011;9(1):72-4.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingown data

    Two included studies did not state the use of guidelines.

    “Two studies did not state the use of guidelines.(26,32)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [26] 26. Berner JE, Gras MDP, Troisi L, Chapman T, Vidal P. Measuring the carbon footprint of plastic surgery: A preliminary experience in a Chilean teaching hospital. J Plast Reconstr Aesthet Surg. 2017;70(12):1777-9. source
    • cites [32] 32. Gatenby PA. Modelling the carbon footprint of reflux control. Int J Surg. 2011;9(1):72-4.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • It may state two separate claims as one.

    Findingcitation

    None of the included studies that compared surgical and non-surgical options considered processes beyond the theatre boundary, and they did not take into account the impact different surgical approaches have on length of stay, infection rate and need for further intervention (all with associated CO2 emissions).

    “However none of these studies considered any processes beyond the theatre boundary, and did not take into account the impact different surgical approaches have on length of stay, infection rate and need for further intervention (all with associated carbon dioxide emissions).”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Findingcitation

    The carbon footprint of surgical approaches to gastro-oesophageal reflux disease treatment is higher than medical treatment up to nine years after the operation, but becomes more carbon efficient thereafter, following patients until end of life.

    “Gatenby (32) found that the carbon footprint of surgical approaches to gastrooesophageal reflux disease treatment is higher than medical treatment up to nine years after the operation, but becomes more carbon efficient thereafter, following patients up until end of life.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [32] 32. Gatenby PA. Modelling the carbon footprint of reflux control. Int J Surg. 2011;9(1):72-4.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • It may state two separate claims as one.

    Findingcitation

    The most carbon intensive approach to gynaecological surgery was robotic, followed by laparoscopic, followed by laparotomy (and trans-vaginal within the former study).

    “(35) found that the most carbon intensive approach to gynaecological surgery was robotic, followed by the laparoscopic approach, followed by laparotomy (followed by trans-vaginal approach within the former study).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] 35. 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. Int J Med Robot. 2015;11(4):406-12. source

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingnone given

    A range of data sources were used for emission factors and GWPs across included studies.

    “A range of data sources were used for emission factors and GWPs.”
    Quote in the paperNot a substantial claim

  • It may state two separate claims as one.

    Findingown data

    The majority of included studies omitted pre- and post-operative processes, patient and staff travel, capital goods manufacture, water use, processing of reusable equipment (all scope three), and pharmaceuticals (including scope one anaesthetic gases).

    “The majority of studies omitted pre-and post-operative processes, patient and staff travel, capital goods manufacture, water use, processing of reusable equipment (all scope three), and pharmaceuticals (including scope one anaesthetics gases).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Findingcitation

    One study found scenario uncertainty varied results by 0.3-19%.

    “whilst another(36) finding this varied results by 0.3-19%.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] 36. Ibbotson S, Dettmer T, Kara S, Herrmann C. Eco-efficiency of disposable and reusable surgical instruments-a scissors case. The International Journal of Life Cycle Assessment. 2013;18:1137-48. source

  • Probably not a substantial claim.

    Premisereasoning

    Carbon footprinting can be used as a tool to model the relative impact of different measures aimed at reducing GHG emissions of operative services, based upon existing variation in surgical care and hypothetical interventions.

    “Carbon footprinting can be used as a tool to model the relative impact of different measures aimed at reducing the GHG emissions of operative services, based upon existing variation in surgical care and hypothetical interventions.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisereasoning

    LCA is an inclusive measure but its endpoints are numerous and vary with approaches and data sources, reducing direct comparisons between studies.

    “LCA is an inclusive measure but the endpoints are numerous and vary with the approaches and data sources used, reducing the extent to which direct comparisons can be made between studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    A top-down EEIO model uses the monetary cost of a unit of interest to estimate carbon footprint, on the premise that more expensive items involve greater resource use with higher associated GHG emissions.

    “The first is a 'top-down' environmentally extended input-output (EEIO) model, which uses the monetary cost of a unit of interest to estimate the carbon footprint, on the premise that more expensive items involve greater resource use, with higher associated GHG emissions.”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [13] 13. Berners-Lee M. How bad are bananas; the carbon footprint of everything. London: Profile Books; 2010.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [17] 17. World Resources Institute. Technical guidance for calculating scope 3 emissions. USA: World Resources Institute; 2013.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • It may state two separate claims as one.

    Premisereasoning

    Estimating the carbon footprint of surgical operations enables their GHG emissions to be quantified and allows identification and targeting of carbon hotspots within surgery.

    “Estimating the carbon footprint of surgical operations enables their GHG emissions to be quantified, and perhaps more importantly, allows the identification and targeting of carbon hotspots (largest GHG contributors) within surgery.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductnone given

    Studies were appraised independently by two researchers using the system detailed in Supplementary Table 2, and discrepancies were discussed and resolved.

    “Studies were appraised independently by two researchers (CR, IS) using the system detailed in Supplementary Table 2, and discrepancies were discussed and resolved.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisereasoning

    Where processes are omitted, this underestimates the carbon footprint of a given process.

    “Where processes are omitted, this underestimates the carbon footprint of a given process.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    The bottom-up process-based method involves collecting data on all component processes underpinning the unit of interest.

    “The alternative 'bottom-up' process-based method involves collecting data on all the component processes underpinning the unit of interest.(13,17)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [13] 13. Berners-Lee M. How bad are bananas; the carbon footprint of everything. London: Profile Books; 2010.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [17] 17. World Resources Institute. Technical guidance for calculating scope 3 emissions. USA: World Resources Institute; 2013.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    EEIO is relatively inexpensive and simple to perform but lacks specificity and detail, and should not be used for comparing carbon footprint of products from within the same industrial sector.

    “It is relatively inexpensive and simple to perform,(17) but lacks specificity and detail, and should not be used for comparing the carbon footprint of products from within the same industrial sector.(19)”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [17] 17. World Resources Institute. Technical guidance for calculating scope 3 emissions. USA: World Resources Institute; 2013.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [19] 19. Berners-Lee M, Howard DC, Moss J, Kaivanto K, Scott WA. Greenhouse gas footprinting for small businesses-the use of input-output data. Sci Total Environ. 2011;409(5):883-91. source

  • Probably not a substantial claim. It may be too vague to check against evidence.

    Premisereasoning

    Despite limitations, a given carbon footprinting methodology can be used to identify hotspots and evaluate alternatives if it is consistently applied within a study.

    “Despite limitations, a given carbon footprinting methodology can be used to identify hotspots and evaluate alternatives if it is consistently applied within a study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisereasoning

    It is often difficult to obtain data on processes beyond the boundary of the hospital under investigation, and the inventory boundary could always be expanded.

    “However, it is often difficult to obtain data on processes beyond the boundary of the hospital under investigation, and the inventory boundary could always be expanded, (e.g. to include higher tier supporting industries such as research and development, or even the food eaten by theatre staff).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    Data were extracted independently by two authors.

    “Data were extracted independently by two authors (CR, IS).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisecitation

    The EEIO approach incorporates all emission sources from upstream processes in the supply chain, including hidden sectors such as marketing and research and development.

    “The EEIO approach incorporates all emission sources from upstream processes in the supply chain (either direct or indirect, and including flow between sectors), taking into account 'hidden' sectors such as marketing, and research and development (e.g.behind the drugs administered during an operation).(18)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] 18. Minx J, Wiedmann T, Barrett J and Suh S. Methods review to support the PAS for the calculation of the embodied greenhouse gas emissions of goods and services. London: Stockholm Environment Institute and University of Minnesota; 2008.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • It may state two separate claims as one.

    Premisenone given

    These previous reviews are predominantly based on low level evidence such as opinion reports, and included studies using a wide variety of methods to measure environmental sustainability.

    “However, these reviews are predominantly based on low level evidence such as opinion reports, and included studies using a wide variety of methods to measure environmental sustainability (e.g.weight of waste, volume of water, and cost).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Study design and conductcitation

    The review was conducted and reported in accordance with PRISMA guidelines and registered with PROSPERO (ID 109928).

    “This review was conducted and reported in accordance with PRISMA guidelines (28) and registered with the International Prospective Register of Systematic Reviews (PROSPERO, ID 109928).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] 28. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • It may state two separate claims as one.

    Premisecitation

    The bottom-up process-based method is resource intensive and requires study boundaries to be carefully defined, resulting in truncation error due to omission of certain processes or hidden sectors.

    “However, this method is resource intensive and requires study boundaries to be carefully defined, resulting in 'truncation error' due to the omission of certain processes, or where the so called 'hidden' sectors are overlooked.(17)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] 17. World Resources Institute. Technical guidance for calculating scope 3 emissions. USA: World Resources Institute; 2013.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Study design and conductnone given

    The search was conducted independently by two authors.

    “The search was conducted independently by two authors (CR, RN).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisereasoning

    The main value of estimating a carbon footprint via an EEIO method is for rapid identification of hotspots, indicating where a more detailed carbon footprint may be useful.

    “The main value of estimating a carbon footprint via an EEIO method is for the rapid identification of hotspots, indicating where it may be useful to perform a more detailed carbon footprint.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    Other investigators have recommended adding reprocessing of single-use devices, environmentally preferable procurement, and energy consumption management.

    “Other investigators have recommended adding in reprocessing of single-use devices (processing to allow for additional use(s)), environmentally preferable procurement, and energy consumption management.(25)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] 25. Kwakye G, Brat GA, Makary MA. Green surgical practices for health care. Arch Surg. 2011;146(2):131-6. source

  • It may state two separate claims as one.

    Interpretationreasoning

    Heterogeneity in functional units, methodology and reporting of results limits comparison across included studies, and means meta-analysis is inappropriate.

    “Heterogeneity in functional units, methodology and reporting of results limits comparison across studies, and means meta-analysis is inappropriate.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Interpretationcitation

    The carbon footprint of different operations will vary, and are likely dependent upon the invasiveness of the procedure, patient factors, and the surgical team, which each impact operative time and consumables used.

    “The carbon footprint of different operations will vary, and are likely to be dependent upon the invasiveness of the procedure, patient factors, and the surgical team, which will each impact on operative time and consumables used.(35)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [35] 35. 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. Int J Med Robot. 2015;11(4):406-12. source

  • It may state two separate claims as one.

    Interpretationreasoning

    The variation in carbon footprint of individual operations may be due to differences in methods and boundaries, but is also affected by the type of operation and the institution where it is performed.

    “This variation may be due to differences in methods and boundaries, but is also affected by the type of operation and the institution where it is performed.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it.

    Premisenone given

    Where included studies used secondary financial activity data within an EEIO model, this incorporates all three scopes of GHG emissions where relevant.

    “Where studies used secondary financial activity data within an EEIO model, this incorporates all three scopes of GHG emissions where relevant.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim.

    Interpretationreasoning

    Failure to state a clear hypothesis increases the risk of post-hoc analysis and selective reporting.

    “No study stated a clear hypothesis, increasing risk of post-hoc analysis and selective reporting.”
    Quote in the paperSubstantial claim

  • It may state two separate claims as one.

    Interpretationcitation

    The preference for reusable rather than disposable items is context specific and may not be universal.

    “Whereas use of reusable rather than disposable items is a good general principle, this preference is context specific and may not be universal.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.

    Premisecitation

    Improving the energy efficiency of USA hospitals by 30% has been estimated could save $1 billion and reduce carbon emissions by 11 million tonnes.

    “Improving the energy efficiency of USA hospitals by 30% has been estimated could save $1 billion and a reduction in carbon emissions of 11 million tonnes.(39)”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] 39. Healthcare without Harm. Health care's climate footprint climate-smart health care series green paper number one. Healthcare without Harm and ARUP; 2019.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • It may state two separate claims as one.

    Premisecitation

    A life cycle assessment study examining seven single use medical devices found that reprocessed devices conferred lower global warming impacts alongside financial benefits.

    “A life cycle assessment study examining seven single use medical devices (including endoscopic trocars, ligasure, arthroscopic shavers and ultrasonic scalpels) found that reprocessed devices conferred lower global warming impacts alongside financial benefits.(51)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [51] 51. Farrelly JS, Clemons C, Witkins S, Hall W, Christison-Lagay ER, Ozgediz DE, et al. Surgical tray optimization as a simple means to decrease perioperative costs. J Surg Res. 2017;220:320-6. source

  • It may state two separate claims as one.

    Interpretationcitation

    Changing processes to only open equipment when needed could bring financial as well as carbon savings.

    “hence changing processes to only open equipment when needed could bring financial as well as carbon savings.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [53] 53. NHS Institute for Innovation and Improvement. Improving quality and efficiency in the operating theatre. Coventry: NHS; 2009.

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • It may state two separate claims as one.

    Premisecitation

    Berner et al. found that an abdominoplasty had a greater carbon footprint than rhinoplasty, which in turn was greater than bilateral breast augmentation.

    “Berner et al.(26) found that an abdominoplasty had a greater carbon footprint than rhinoplasty, which in turn was greater than bilateral breast augmentation.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] 26. Berner JE, Gras MDP, Troisi L, Chapman T, Vidal P. Measuring the carbon footprint of plastic surgery: A preliminary experience in a Chilean teaching hospital. J Plast Reconstr Aesthet Surg. 2017;70(12):1777-9. source

  • It may state two separate claims as one.

    Premisecitation

    Thiel et al. modelled that the carbon footprint of a hysterectomy operation could be reduced by up to 83% through optimising the instrument tray via minimal materials and maximum reuse (49%), switching anaesthesia to intravenous anaesthesia with propofol or similar agents (28%), and using renewable energy (6%).

    “Thiel et al. (33) modelled that the carbon footprint of a hysterectomy operation could be reduced by up to 83%, through optimising the instrument tray via minimal materials and maximum reuse(49%), switching anaesthesia to intravenous anaesthesia with propofol or similar agents (28%), and using renewable energy (6%).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [33] 33. Thiel CL, Woods NC, Bilec MM. Strategies to reduce greenhouse gas emissions from laparoscopic surgery. Am J Public Health. 2018;108(S2):S158-S64. source
61 of 61

  • The paper relies on this without support.

    The principal components making up the carbon footprint of an operating theatre are hospital infrastructure, capital machinery, maintenance of the theatre environment, electronic equipment energy, water, anaesthetic gases, pharmaceuticals, and reusable and disposable items.

    “The principle components making up the carbon footprint of an operating theatre are the hospital infrastructure, capital machinery, maintenance of the theatre environment (heating, ventilation, air-conditioning, lighting), electronic equipment energy, water, anaesthetic gases, pharmaceuticals, and reusable and disposable items.”

  • The paper relies on this without support.

    A carbon footprinting study is most reflective of true emissions when all processes attributable to the functional unit from all three scopes are included.

    “A carbon footprinting study is most reflective of true emissions where all processes attributable to the functional unit (from all three scopes) are included.”

  • The paper relies on this without support.

    There are three major sources of uncertainty within carbon footprint studies: parameter uncertainty, scenario uncertainty, and model uncertainty.

    “There are three major sources of uncertainty within carbon footprint studies, and each of these were considered.”

  • The paper relies on this without support.

    Hotspots will vary in different settings and with different operations.

    “and hotspots will vary in different settings and with different operations.”

  • The paper relies on this without support.

    Improving the environmental impact of surgery often leads to financial benefits.

    “Improving the environmental impact of surgery often leads to financial benefits and these should be reported alongside surgical carbon footprints”
5 of 5

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Method-category counts exceed the number of included studies

    Minor

    The paper reports eight eligible studies, but its counts of three exclusively bottom-up, one exclusively top-down, and five hybrid studies total nine. Those categories cannot overlap as described.

    Reported 8 · recomputed 9

  • Study 35 is assigned two exclusive methods

    Minor

    Study 35 is listed both as exclusively bottom-up and as exclusively top-down. It cannot exclusively use both methods.

2 of 2

Citations

Cites

Flagged first, then by citations

4 of the 54 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Metadata

Authors
Rizan, C., Steinbach, I., Nicholson, R., Lillywhite, R., Reed, M., & Bhutta, M. F.
Affiliations
  • Brighton and Sussex Medical School (GB)
  • Centre for Sustainable Healthcare (GB)
  • University Hospitals of Leicester NHS Trust (GB)
  • University of Warwick, Coventry, United Kingdom
Corresponding author
  • Rizan, Chantelle
  • Bhutta, Mahmood F.
ORCID
Venue
Annals of Surgery
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2020-06-08
Volume
272
Issue
6
Pages
986-995
ISSN
  • 0003-4932 (ISSN-L)
  • 1528-1140
DOI
10.1097/sla.0000000000003951
OpenAlex
W3014488149
Cited by
400
References
54
Citations by year
2026: 84 · 2025: 89 · 2024: 99 · 2023: 70 · 2022: 41 · 2021: 16 · 2020: 1
FWCI
2.63
Type
journal article
Language
en
Open access
Locations
  • Annals of Surgery (publishedVersion)
  • PubMed (publishedVersion)
  • Sussex Research Online (University of Sussex) (submittedVersion)
  • Warwick Research Archive Portal (University of Warwick) (submittedVersion)
Topics
  • Physical Sciences › Environmental Science › Environmental Engineering › Environmental Impact and Sustainability
  • Physical Sciences › Engineering › Architecture › Healthcare Facilities Design and Sustainability
  • Social Sciences › Decision Sciences › Management Science and Operations Research › Healthcare Operations and Scheduling Optimization
Keywords
carbon footprint, surgical procedures, operating room, environmental impact of surgery, CO2 emissions, power consumption, surgical consumables, energy efficiency, medical waste
MeSH terms
Humans, Operating Rooms, Surgical Procedures, Operative, Carbon Footprint

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-10-11, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-10-11 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Cited sources are checked with a language model’s help (gpt-6-sol).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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