647 Sustainability in Abdominal Wall Reconstruction: An Eco-Audit of the Abdominal Wall Reconstruction Pathway

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Abstract Aim Abdominal wall reconstruction is a procedure requiring input from multiple specialities and is often performed on complex multimorbid patients. These patients often require a high level of care, the environmental impact of which has yet to be explored. Method A retrospective study of 23 patients undergoing abdominal wall reconstruction at a single centre was performed. Process mapping and life-cycle analyses were performed for surgical and inpatient stay including facilities, consumables, medical gases, equipment, food and linen and travel. Estimates for carbon dioxide emissions were generated for each stage of the care pathway, with variability considered, as well as potential areas of savings. Results This study estimated the carbon footprint of a patient undergoing abdominal wall reconstruction surgery to be approximately 669.56kgCO2eq. Inpatient stay overwhelmingly had the highest overall contribution to the carbon footprint (558.0kgCO2eq., 83.3% overall pathway emissions). From bottom-up calculations, patient travel was the predominant source of carbon emissions (58.47kgCO2eq, 52.41%) followed by the production and transport of equipment and building electricity, gas, oil and water usage. Conclusions This is the first study to estimate the carbon footprint of a surgical pathway for complex patients, using abdominal wall reconstruction as an example. Strategies to combat the impact of carbon emissions and increase sustainability included increased implementation of Enhanced Recovery After Surgery protocols to reduce inpatient stay, increased accuracy of waste segregation and continued use of total intravenous anaesthetic.

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