The United Nation’s Sustainable Development Goals (SDGs) 12 and 13 address ‘responsible consumption of resources’ and ‘action to combat climate change.’ Healthcare providers often overlook these goals, despite the large consumption of resources and emissions of greenhouse gases (GHG) from healthcare services in developed countries. Cataract surgery is one of the most common medical procedures performed worldwide and the absolute number of surgeries is expected to increase with the World Health Organization’s (WHO’s) Vision 2020 Initiative to eradicate cataract blindness globally. A 2013 study of cataract surgery in the United Kingdom (UK) found that the procurement of largely disposable supplies resulted in over half of their GHG emissions per case. Aravind Eye Care System is a recognized medical institution noted for their efficient process design, excellent patient outcomes, and low cost of care; but their surgical practices have never been studied from an environmental perspective. Aravind also happens to reuse nearly all of their surgical materials and instruments, making them an interesting case in effective alternative approaches to material use in healthcare delivery.
This study analyzes the environmental life-cycle emissions from an average cataract surgery at Aravind Eye Hospital in Pondicherry, India, to determine best practices for targeting SDGs 12 and 13 within the medical field. We observed >100 cataract cases at Aravind in Puducherry, India between November 2014 and March 2015. Data on the quantity, cost, and disposal/treatment processes for surgical materials were recorded through direct observations, waste auditing, and interviews with Aravind staff. Energy and water consumption for each case was estimated using hospital-wide data. This hybrid LCA framework utilized ecoinvent unit process data for the LCI phase, and TRACI (primary) and CML (sensitivity test) methods for the LCIA phase. There are very limited data about pharmaceuticals in existing LCI process databases, and therefore, this study used EIO-LCA data to estimate the associated emissions from intraoperative drug use.
Aravind emits about 6kg CO2-equivalents per case, with a majority coming from the sterilization of reusable instruments. Reusable instruments result in a majority of emissions (35-75%) in all impact categories except ozone depletion and non-carcinogens. Despite minimal use of single-use instruments and materials, the production of these items results in 25-65% of emissions per case in the categories of ozone depletion, carcinogens, ecotoxicity, and cumulative energy demand.
Aravind generates less than 5% of the UK’s 160kg CO2-e per phaco, showing that some institutions in developing countries may offer effective solutions to minimizing resource use and combatting climate change within the medical field. Though US facilities face a larger regulatory burden, initiatives such as regular reviewing of physician preference cards, minimizing unused-unopened waste, waste segregation allowing for recycling, and environmentally preferred purchasing and supply chain may help reduce the carbon footprint – and adverse public health impacts - of cataract (and other medical) care.
• Industrial ecology in developing countries , • Life cycle sustainability assessment , • United Nations Sustainable Development Goals
